REPUBLIC OF CROATIA MINISTRY OF HEALTH AND SOCIAL WELFARE

Programme: IPA 2008

Partner Country: Croatia

Area of Cooperation: Right of establishment and freedom to provide services

IPA TWINNING LIGHT PROJECT FICHE

“Rising the knowledge and skills of nurses and midwives

and

harmonizing educational curricula with Directive 2005/36/EC “

Project budget: EUR 230.000

- 1 - STANDARD TWINNING PROJECT FICHE

1. Basic Information 1.1 Programme: IPA 2008 – Facility for Project Preparation and Reinforcement of Administrative Capacity 1.2 Twinning Number: HR/2008/IB/SO/01TL

1.3 Title: Raising the knowledge and skills of nurses and midwives and harmonizing their educational curricula with Directive 2005/36/EC 1.4 Sector: Mutual recognition of professional qualifications

1.5 Beneficiary country: Republic of Croatia

2. Objectives 2.1 Overall Objective:

Alignment with the acquis communitaire in the relevant field of nursery and midwives in the Republic of Croatia.

2.2 Project purpose:

Modernization of the educational curricula for the nurses and midwives and compensating the difference in competences with the Directive 2005/36/EC through bridging programmes.

2.3 Contribution to Accession Partnership/ Stabilisation and Association Agreement/ National Programme for Integration of the Republic of Croatia into the EU (NPIEU)

The „Accession Partnership“ for the integration of the Republic of Croatia in European Union identifies priorities that are expected to be completed prior to the accession. This project will partly address priority that applies to Chapter 3: Right of establishment and freedom to provide services. It will tackle the issue of alignment of legislation with the acquis regarding recognition of professional qualifications for EU citizens, removing the barrier to the right and freedom to provide services for nurses and midwives.

According to the Republic of Croatia 2008 Progress Report under Chapter 3: Right of establishment and freedom to provide services, improvement is needed in the area of mutual recognition of professional qualifications. The minimum training requirements for the medical professionals (amongst them are midwives and nurses) are still not in the line with the acquis. The nurses training at the secondary and higher level and the midwifery education on secondary level fall short of the requirements set out in Directive 2005/36/EC. The administrative capacity of the authorities dealing with both mutual recognition of qualifications and with coordination and alignment with the acquis as regards freedom to provide services needs to be strengthened.

National strategy of Health Care 2006 – 2011 emphasizes the necessity of harmonization of Croatian health care system with the EU standards. Chapter 3.3.2 it states that significant factor in delivery of health and patient care in Croatia is the number of nurses, which is in the current situation of ageing population

- 2 - insufficient. With the number of only 5.2 nurses per 1000 inhabitants in 2004, Croatia falls well behind the EU standards by almost 60%. Disturbing fact is the negative deviation i.e. drifting away from the EU average.

VET (Vocational Education and Training) System Development Strategy in the Republic of Croatia 2008 – 2013 was adopted by the Croatian Government in July 2008, as mentioned in Chapter 26: Education and Culture of Croatia 2008 Progress Report. One of the objectives of the VET System Development Strategy is to create mechanisms of comparability and recognition of Croatian vocational qualifications in Europe.

National Programme for Integration of the Republic of Croatia into the EU (NPIEU) from 2008 states certain priorities to be finished in 2008 in connection to health sector. The Republic of Croatia conducted the activities aiming at the change of legislation for health care workers, finished by the end of third quarter 2008. New Nursing Act was passed in September 2008 in order to fulfil EU requirements and first Midwifery Act was passed in October 2008 regulating this profession.

According to the Republic of Croatia Progress Report for 2009 under Chapter 3: Right of establishment and Freedom to provide services, there has been a progress on the field of mutual recognition of professional qualifications. However, minimum training requirements are still not in compliance with the acquis. The new Act on Regulated Professions and the Recognition of Foreign Professional Qualifications from September 2009 regulates both the recognition of foreign professional qualifications and creates a legal basis to ensure that the minimum training requirements of the acquis will become applicable as from the day of accession. Administrative capacity to deal with the mutual recognition of qualifications needs to be strengthened. Preparations in the field of mutual recognition of professional qualifications are advancing. Chapter 3 of accession negotiation was provisionally closed on 21 December 2009.

3. Description 3.1 Background and justification: Background

In July 2008 Ministry of Health and Social Welfare hosted Peer Assessment mission for five professions regulated by the Directive 2005/36/EC (doctors of medicine, doctors of stomatology, pharmacists, nurses and midwives). In the delivered Peer Assessment report it was emphasized that education of nurses and midwives is still not harmonized with the above mentioned Directive. Discrepancy especially refers to the insufficient number of years of general education, which in the Republic of Croatia lasts for 8 year, while minimum EU standard is 10 years.

In February 2009, Ministry of Science, Education and Sports introduced Vocational Education and Training Act which, under article 5 (3), reads that “Exceptionally, participants of programmes for acquirement of medical qualifications, after finishing a two-year general part of education, receive a certificate whose content and form is determined by the Minister” which compensate the before mentioned conclusion, i.e. the newly adopted Act ensures that there is sufficient number of years of general education for nurses in Republic of Croatia that lasts 10 years in compliance with EU standards. The provisions of the Act will be applicable as of academic year 2010/2011.

However, this Act does not refer to midwifery education; so, there is still discrepancy in regard to insufficient number of years of general education for the education of midwives.

Also, during negotiation process in 2009 for Chapter 3, the European Commission accepted Croatia’s explanation in regard to delivered Peer Assessment report which emphasized that education of nurses is still not harmonized with the Directive. In this explanation Croatia clearly additionally stated that members of Peer Assessment Mission did not have access to full documentation about nursing education in Croatia. Therefore, the latest state of affairs is that the European Commission accepted Croatia’s argumentation regarding the

- 3 - education of nurses. The nurses who have completed vocational education, internship and passed state examination will be entitled to automatic recognition of their diplomas in accordance with the Directive. This recognition is ensured under acquired rights under the Directive and refers to fulfilment of conditions laid down in Art 23 (1) in conjunction with Art 33(1) of the Directive. The recognition, therefore, refers to those individuals who will be working in Croatian health system for at least three years, counting five years period from the date of Croatian accession to European Union.

It should be noted that the Directive has determined three years as minimum number of years for education of nurses, including at least 4600 hours, of which at least one third must be theoretical education and at least one half training lessons. Out of this theoretical part of education should be at least one third and practical education at least one half of curriculum. In the Republic of Croatia (the educational programme valid in academic year 2009/2010) the number of years of professional education for nurses after the end of eight years of general education is four years of high school and one year of internship totalling in 6296 hours. However, only 4203 hours are of a professional content which falls short of some 400 hours according to the Directive.

Also the competences of nurses are not completely aligned with the requirements of the Directive. The curriculum implemented in the school year 2010/2011 should change in terms of the following: content and supporting guidelines of Supplement V.2 of the Directive, increase in the number of hours for theoretical part of education, inclusion of internship in the practical element of the basic nurse education in order to compensate necessary number of hours of clinical practice in the curriculum, and finally to equalize the total number of hours in the sense of minimum conditions from the article 31, paragraph 3, which is 4600 of hours.

The Professional Committee whose members came from the Ministry of Health and Social Welfare, Ministry of Science, Education and Sports, Agency for Vocational Education and Training1 and principals of nursing education institutions prepared a national nursing educational curriculum in accordance with the Directive. This curriculum was completed in October 2009 and is in the process of assessment by the European Commission with the intention to be implemented in academic year 2010/2011. The implementation of this curriculum in academic year 2010/2011 would satisfy Croatia’s compliance with the acquis.

Regarding the education of midwives, the Directive does not specify the number of hours of professional contents nor the duration of education. On the other hand, competences of midwives and what midwives after the end of existing educational programme have acquired are described in detail. Midwives’ education in the Republic of Croatia is conducted at the high school level consisting of 6801 training hours. Out of this number 4345 hours is allocated to the professional education. The education of midwives in the Republic of Croatia that is potentially compliant with the Directive refers to the curriculum for midwives offered at higher education level. The curriculum offered at this level in academic year 2008/2009 is offered by the University of Rijeka. The curriculum refers to three-year curriculum (first cycle of the so-called Bologna studies). The persons graduating from the curriculum receive Bachelor’s degree in professional studies. However report of the Peer Assessment mission did not positively assess this programme and appraised it as insufficient in relation to requirements of the Directive. Specific disadvantages refer to the fact that existing programme is not a full-time programme and thus does not comply with the Directive. Practical training is set in the curriculum in the terms of hours, but does not give enough details. Midwives that are educated according to this programme perform practical work under the constant monitoring of doctors and not independently as required. The modules which are lacking are such modules as modules regarding the role of the midwife, midwives in society, midwives in European and international context, physiology and the pathogenesis of pregnancy, the development of decision making skills and legislative framework, the processes of referral to the obstetrician. Currently, a new curriculum for bachelor’s degree for midwives (three-year professional studies programme) is being created and is under the process of evaluation by Zagreb University, Faculty of Medicine. It is expected for the curriculum to be completed and licensed in accordance with the procedure in place by the first quarter

1 The name of the agency will be changed into Agency for Vocational Education and Training and Adult Education

- 4 - of 2010. Its implementation is expected in academic year 2010/2011. The implementation of this curriculum in academic year 2010/2011 would satisfy Croatia’s compliance with the acquis.

In order to fulfil the request which refers to the patients rights on equal quality of medical service on the whole territory of the EU provided by an adequately educated health care professionals, it is necessary to equalize the competences of nurses and midwives which currently work in the Croatian health system and have completed the formal education available in Croatia prior to academic year 2010/2011It is essential to make adequate bridging programmes for nurses that are not special upgrading programme in the sense of the Directive 2005/36/EC. It is also essential to create adequate bridging programmes as a part of formal education for midwives (special upgrading programmes). The completion of bridging programmes for nurses will not allow for automatic recognition of the qualifications in the EU Member States and the responsible body in the EU Member State will be able to decide on an individual case basis (taking all other additional factors in question) whether qualifications of an individual can be recognized in that specific country.

The results of this project will help to improve mobility of the patients and quality of health care.

3.2 Linked activities (other international and national initiatives): In July 2008 Ministry of Health and Social Welfare hosted Peer Assessment mission for five professions regulated by the Directive 2005/36/EC (doctors of medicine, doctors of stomatology, pharmacists, nurses and midwives). Also, in the Republic of Croatia there were five TAIEX- assisted workshops for nurses and midwives held in January and April 2007, in January 2008, in July 2009 and in October 2009. Those workshops were organized by the Ministry of Health and Social Welfare, Croatian Nurses Association and Croatian Midwifery Association. It was recommended that activities of aligning education and competences for nurses and midwives in the Republic of Croatia with the Directive 2005/36/EC should be undertaken in the near future.

The results of the peer assessment mission for the education of nurses and midwives are as follows:

1) NURSES: PART III: CONCLUSIONS

A. Overall Assessment Overall, the education of nurses at the lower level, does not meet the requirements of Directive 2005/36/EC for the nurses responsible for the general care. Nurses graduated from this type of education need to upgrade their knowledge and skills up to the minimum level that is required by the European Directives. The education of nurses at the higher level presents limitations as regards the content of the theoretical part of education and especially as regards the total number of hours’ requirement. More improvements are needed in the area of the regulation of the profession.

2) MIDWIVES CONCLUSIONS A. Overall assessment

The midwifery education programme being taught at the Secondary School for the profession of midwives does not meet the requirements for the education of midwives as outlined in Directive 2005/36/EC. All the staff we met was fully aware of this situation and was eager to see remedial legislative changes in the education of midwives in Croatia. All personnel were aware (i) that the entry requirement did not meet the requirements of the Directive 2005/36/EC, (ii) that the content did not meet the requirements

- 5 - and (iii) that midwives educated on this programme practised under the constant supervision of a doctor and did not practise autonomously in any area of maternity care. The absence of legislation on the profession and practice of midwives was cited as limiting the development of the practice and education of midwives in Croatia.

In an attempt to address the anomalies in the current midwifery education programme, a higher level education programme commenced at the University of Rijeka in April 2008. This part-time, three year programme, is still at a developmental stage: the theoretical content of year one has been developed but year two and year three are not yet developed or planned. This inhibits the full assessment of this programme in terms of its future ability to meet Directive 2005/36/EC.

Overview of Taiex workshops:

1) The aims of Taiex workshop in January 2007  To develop a peer review related to education, training and practice of nurses and midwives, possibly to be expanded to other health professions (doctors, dentists, pharmacists) and act in conformity with the outcomes thereof;  To ask assistance from the EU in this field, for instance by means of further TAIEX-missions, one or more twinning-projects or other options;  To provide the means to the Croatian Nurses Association as well as to the Croatian Midwifery Association to have their representatives fully participate in this process, other than on voluntary basis.  To bring the general educational system up to European standards required for the process of mutual recognition of qualifications to become relevant.  To bring the regulatory system for nurses and midwives (and possibly: for other health professions) in line with European requirements, thus effectively implementing the mutual recognition system for nurses and midwives (and other health professions);  To not only safeguard the required legal changes but to develop and execute clear implementation plans as well.

2) The aims of Taiex workshop in April 2007  Need for a PEER REVIEW,  Other forms of outside assistance, such as in the Dutch MATRA-program (specifically matra-flex), TAIEX as well as a EU-twinning instrument  Develop new midwifery curriculum, mandatory national curriculum of at least three years;  There should be the opportunity for train-the-trainer programmes in order to further enhance the development and implementation of the new curriculum  Develop and implement a midwifery law, in line with Directive 2005/36/EC.  Options for bridging programmes for midwives, educated under the current system

Conclusions of this Taiex work shop include following recommendations: Recommendation 15: It is recommended to reform nursing and midwifery education to ensure compliance with the EU-Directive 2005/36/EC, while protecting the status of those trained on programs that do not comply (through the creation of bridging courses). The outcomes of the recommended PEER REVIEWS should serve as a basis for this harmonisation.

Recommendation 22:

- 6 - With respect to the possibilities of an EU-twinning project, it is recommended that the Croatian authorities apply to the EC for a Twinning project concerning the mutual recognition of healthcare professions. To this end, it is also recommended that Croatian authorities, in co-ordination with EC DG-Enlargement and possibly with other external support, develop an EU-twinning fiche in a preparation of this Twinning.

3) Taiex workshop in January 2008 was organized to provide the participants with the relevant information related to Directive 2005/36/EC and other relevant EU developments. The aim was to develop a mutually agreed implementation strategy including the development of clear recommendations. The working sessions dealt with:  Developing the Croatian National Nursing (and Midwifery) Strategy;  Developing the Croatian National Nursing (and Midwifery) Strategy in the light of EU-accession;  Curricula;  Peer reviews. The aim was also to finalize the recommendations and to seek options with key players to bring the recommendations further.

4) The conclusions of of Taiex workshop July 2009:

 It is recommended to the Croatian Government to urgently restructure the Croatian educational system:

a. from primary to university level

b. in order to ensure that prospective midwifery students have the prerequisite education and training (min. 10 years general school education, art. 40, 2.a , of Directive 2005/36/EC, in practice meaning: primary school, gymnasium) prior to accessing university.

 It is recommended to the Croatian Midwifery Chamber, the Croatian Association of Midwives and all other relevant stakeholders urgently to communicate these requirements as widely and as soon as possible.

 It is recommended to all relevant stakeholders urgently to start a full review of content and delivery of the midwife registration education programme, including:

a. Delivery of educational programme at university level;

b. Education/preparation/training of midwife-lecturers/teachers;

c. Identification and preparation or practice environment.

 It is recommended to the Croatian Government that, in order to achieve the above, Croatian midwifery education programmes should urgently gain access to up-to-date appropriate (scientific) texts, journals and facilities in the Croatian language.

 It is suggested that the above recommendations can and should be achieved with:

- 7 - a. Support – in terms of both human and financial resources - from the Ministry of Health and Social Welfare, the Ministry of Science and Education and

b. Access to EU Structural funds;

c. Other EU-programmes such as the Erasmus programme (including University twinnings);

d. Possible bi-national support programmes.

5) The conclusions of Taiex workshop in October 2009  The negotiation process needs to reach international standards of transparency and therefore be open to the public and especially the stakeholders in this process  The Croatian government should set up monitoring systems for the implementation of 2005/36/EC which is above the individual government ministries with roles to play in this process  Those responsible for the current provision of nurse education should be identified, as should those who will be responsible for nurse education in the post-accession period. In particular a public strategy needs to be announced to explain the role and function of nurses still emerging from the non-compliant secondary, vocational school system  Legislation will be required to achieve full compliance with 2005/36/EC. To deliver this it is important to identify the policy framework for achieving that. This will require: a) Mapping exercise to identify in detail the nature of what has existed previously during the lifetime of any nurses still practising in Croatia b) Undertake exercises in all the regions to raise awareness of what has to be achieved and how it is to be done c) Establish a committee with nursing leadership to overview the work to be done and with the powers to ensure its delivery d) Retain legal advisers to draft the legislation and agree the parliamentary schedule to its enactment and transposition  Develop bridging programmes as described above to: - a) Meet the needs for retraining of those nurses who have not been working health system for at least three years during the period of five years from the date of Croatian accession to EU b) Meet the needs of those still in training at the point of accession c) Respond to the wishes of those nurses who while recognised in the terms of 2005/36/EC, wish to be seen to have raised their level of knowledge and practice to that of the rest of the EU workforce  Develop a department of nursing and midwifery in the Department of Health with the resources and powers to overview the delivery of nursing policy in relation to the legal requirements for nursing and midwifery care in Croatia, across all government departments and agencies. In particular, to raise the awareness of nurses in order to develop a vision of higher quality healthcare, and how that would increase professional autonomy  It is the responsibility of the Croatian government to ensure the criteria for the harmonisation of nurse education is completed in a manner which generates international trust in governments and professional regulators across the EU

3.3 Results:

Result 1

- 8 - Current educational curriculum for nurses analysed as well as insight and acquired knowledge in current curriculum for the training of nurses harmonized with the Directive 2005/36/EC;

Result 2 Bridging programme I for the nurses (with less than three-years work experience and completed secondary education enrolled before academic year 2010/2011) and bridging programme II for the nurses who entered secondary education prior to academic year 2010/2011) developed

Result 3 Current educational curriculum (currently offered by Rijeka University) for midwives analysed and recommendations for possible changes prepared.

Result 4 Competences for the midwives analysed and recommendations for possible changes prepared.

Result 5 Basic educational materials (hand outs) for future educators/instructors who will in the future be responsible for education of trainers that will teach (directions, recommendations, obstacles, etc.) on curriculum and bridging programs prepared and consolidated.

- 9 - 3.4 Activities:

Activities related to result 1: Analysis of educational curriculum for nurses 1.1. Conducting analysis of the current educational curriculum for nurses which is being developed and implemented in academic year 2010/2011 1.2. Organising and conducting study visits (5 working days, 10 participants) to a relevant EU member state for working group members and other relevant stake-holders.

Activity related to result 2: Preparation of bridging programmes I and II. for the nurses 2.1 Conducting analysis of existing competences of nurses and its comparison with the Directive 2005/36/EC 2.2 Preparation of bridging programme I (modules, (theory) exam, checks of skills etc.) in order to equalize nurse competences with the Directive 2005/36/EC. (for nurses with less than three years work experience and completed secondary school education enrolled before academic year 2010/2011, and finished internship and state examination) 2.3 Conducting the comparison of curriculum from academic year 2009/2010 to the one which is in line with Directive and in practice in academic year 2010/2011 and analysis and comparison of competences that result after the completion of two above mentioned curriculums. 2.4 Preparation of bridging programme II (modules, (theory) exam, checks of skills (practical exams) etc.) in order to equalize competences of nurses with the Directive 2005/36/EC. (for nurses who entered secondary school and are in the process of education before academic year 2010/2011)

Activity related to result 3: Analysis of educational curriculum for the midwives 3.1 Conducting analysis of current educational curriculum for midwives and its comparison with the Directive 2005/36/EC 3.2. Preparation of recommendations for possible changes (modules, theory, checks of skills (practical exams) etc) 3.3. Organization of a study visit (5 working days, 6 participants) to the learning institution in the EU Member States.

Activity related to result 4: Analysis of the competences for the midwives 4.1 Conducting analysis of existing competences of midwives and its comparison with the Directive 2005/36/ EC. 4.2 Preparation of recommendations for possible changes.

Activity related to result 5: Preparation of basic educational materials for curriculum and bridging programs 5.1. Preparation and consolidation of basic educational materials (hand outs, copies) on curriculum and bridging programs resulted from all of the previous activities.

Two visibility events will be organized in the course of the implementation of the project; Kick-off meeting at the start of the implementation and the Final meeting at the end of the implementation of the project activities.

- 10 - Date/Duration Activity Output Input Month 1 Activity 1.1. Conducted analysis of the current educational 2 experts in total of 16 curriculum for nurses which is being developed and working days implemented in academic year 2010/2011 Activity 3.1. Conducted analysis of current educational curriculum 2 experts in total of 8 working for midwives and its comparison with the Directive days 2005/36/EC Activity 3.2. Recommendations for possible changes (modules, 2 experts in total of 8 working theory, checks of skills (practical exams) etc) prepared days TOTAL: 32 working days Month 2 Activity 1.2. and Study visits organised and conducted: Activity 3.3. a) (5 working days, 10 participants) to a relevant EU member state for working group members and other relevant stake-holders) b) (5 working days, 6 participants) to the learning institution in the EU Member States. Activity 2.1. Analysis of existing competences of nurses and its 2 experts in total of 8 working comparison with the Directive 2005/36/EC conducted days Activity 2.3. Conducted the comparison of curriculum from academic 2 experts in total of 8 working year 2009/2010 to the one which is in line with Directive days and in practice in academic year 2010/2011 and analysis and comparison of competences that result after the completion of two above mentioned curriculums. Activity 4.1. Conducted analysis of existing competences of midwives 2 experts in total of 8 working and its comparison with the Directive 2005/36/ EC. days TOTAL: 24 working days Month 3 – 5 Activity 2.2. Bridging programme I prepared(modules, (theory) 2 experts in total of 25 exam, checks of skills etc.) in order to equalize nurse working days competences with the Directive 2005/36/EC. (for nurses with less than three years work experience and completed secondary school education enrolled before academic year 2010/2011, and finished internship and state examination) Activity 2.4. Bridging programme II prepared (modules, (theory) 2 experts in total of 25 exam, checks of skills (practical exams) etc.) in order to working days equalize competences of nurses with the Directive 2005/36/EC. (for nurses who entered secondary school and are in the process of education before academic year 2010/2011) Activity 4.2. Recommendations for possible changes in regard to 2 experts in total of 50 conducting analysis of existing competences of working days midwives and its comparison with the Directive 2005/36/ EC prepared TOTAL: 100 working days Month 6 Activity 5.1. Basic educational materials (hand outs, copies) on 2 experts in total of 28 curriculum and bridging programs resulted from all of working days the previous activities prepared and consolidated TOTAL: 28 working days Total Min. 184 working days working days

- 11 - 3.5 Means/ Input from the MS Partner Administration:

3.5.1 Profile and tasks of the Project Leader

Requirements: - University level education or equivalent professional experience of 13 years in health care - 10 years of professional working experience in the relevant body responsible for nurses and/or midwives - experience in implementing Directive 2005/36/EC in the area of nursing and/or midwifery - project management experience - fluency in English, both written and spoken - proven contractual relations to public administration or mandated body, as defined under Twinning manual 5.3.2.

Assets: - at least 1 year work experience in transition on/or pre-accession countries - coordinate and organize study visit, training activities, workshops and public awareness activities - professional experience in the field of education of nurses and midwives in member states

Tasks: - overall management and coordination of the whole project and particular activities, in cooperation with Croatian PL - organization of meetings - co-ordination of MS experts work and availability - close cooperation with the Croatian experts in undertaking activities - preparing and submitting a Start-up and Final report - design and organization of study visits - co-chairing, with the Croatian PL, the regular project implementation steering committee meetings; - mobilizing short- term experts; - ensuring backstopping and financial management of the project in the MS

- 12 - 3.5.3 Profile and tasks of the short-term experts

Expert for nurses (STE 1)

Requirements: - University level education or equivalent professional experience of 10 years in health care - 5 years of work experience in the field of education and practical work of nurses - fluency in English, both written and spoken - experience with the implementation of Directive 2005/36/EC

Assets: - work experience in transition on/or pre-accession countries

Tasks - plan and coordinate outputs - to prepare outputs in the required field of expertise in co-ordination with the Project Leader and the Croatian Ministry of Health and Social Welfare

Expert for midwives (STE 2)

Requirements: - University level education or equivalent professional experience of 10 years in health care - minimum 5 years of work experience in the field of education and practical work of midwives - fluency in English, both written and spoken - experience with the implementation of Directive 2005/36/EC - experience in developing or teaching curriculum in line with the Directive 2005/36/EC

Assets: - work experience in transition on/or pre-accession countries

Tasks - to plan and coordinate outputs - to prepare outputs in the required field of expertise in co-ordination with the Project Leader and the Croatian Ministry of Health and Social Welfare

- 13 - 4. Institutional Framework

Final beneficiary the Ministry of Health and Social Welfare (MHSW) – Directorate for Medical Affairs, Department for projects and programs. Role of Ministry is to create health policy and laws that determine the quality of health services in the Republic of Croatia. In all its activities the Ministry consults social partners (e.g. Croatian Nurses Council, Croatian Chamber of Midwives, Croatian Nurses Association, and Croatian Midwives Association).

The important stakeholders, when it comes to the implementation of the educational programs, are the Agency for Vocational Education and Training (AVET), the Ministry of Science, Education and Sports (MSES) and the University in Rijeka. Based on the laws regulating the education system in the Republic of Croatia, MSES approves the introduction of a designated educational programme. Based on that approval the programme is implemented in the educational system in the Republic of Croatia. In order for an educational programme to be approved by the MSES, its main feature should be usability. For this reason MSES experts work together with the institutions that develop educational programmes. They participate in the drafting of the programmes, giving necessary guidelines, and assuring that the programme has all necessary features.

The Agency for Vocational Education and Training (AVET) was founded under a Decree of the Government of the Republic of Croatia in January 2005 (OG 10/2005). The AVET is a key stakeholder for VET in Croatia with a mandate for planning, development, organization, monitoring and evaluation of VET system in Croatia. In accordance with the legal basis and the statute/relevant amendments, the AVET performs key developmental and advisory activities and serves as the focal point for the state institutions, social partners and international organisations in the field of VET. Currently, the AVET’s core activities are as follows:  Development of modern curricula based on learning outcomes, knowledge, skills and competences;  Defining pedagogical standards in VET;  Developing VET management informational system (VETIS), and collecting and analysing data that can help in successful planning of the system;  Coordinating activities of development and reviewing occupational standards and VET qualifications and cooperating in the development of the Croatian qualification framework;  Organising and conducting in-service education and training of VET teachers, and exams for probationers;  Following up the work of VET teachers and promoting VET teachers into professor – mentor or professor– adviser posts;  Organising and conducting student competitions in the field of VET.

AVET employs 54 staff members (information current in April 2009).

University of Rijeka is currently the only University providing for the education of midwives in Croatia. It offers a three-year undergraduate study for midwives. According to the Act on the Science and Higher Education, Universities in Croatia are autonomous institutions, competent for drafting of the educational programs. These programmes are then sent in the MSES, which performs the authorization procedure and allows the implementation. For the purpose of better coordination MHSW will form the Project implementation unit in which representatives of Ministries of Health and Social Welfare, Ministries of Science, Education and Sports, Agency for Vocational Education and Training and the University of Rijeka will serve for the purpose of coordination of designated activities.

According to VET Act, Ministry of Education, Science and Sports formed Sectoral Council for health and social welfare on April 28th, 2009. This Sectoral Council:

- 14 - - defines the needs for professional qualifications, - analyzes existing and future competencies, - decides on the context for professional qualification standards, - promotes health and social welfare sector and employment opportunities in this sector, - proposes the establishment of curriculum and relevant institutions for vocational education - Sets the profiles of health workers to be educated in this sector.

Projects results will not lead to any institutional framework changes.

Croatian Nurses Association (CNA) is non-governmental association that gathers nurses from all over the Republic of Croatia and stands for the modern, transparent organization that stimulates members´ creativity and innovations. It effectively contributes to Croatian health care improvement and nursing education, leadership and professional development. Croatian Nurses Association (CNA) presents an important factor in domestic and international nursing aiming at the constant improvement of the health care in general. As national association representative of nurses of Republic of Croatia, the association is also a member of International Council of Nurses (ICN), European Federation of Nurses Association (EFN), Nursing and Midwifery Associations and World Health Organization. Ministry of Health and Social Welfare closely cooperates with the Croatian Nurses Association especially in the segment of permanent wave of training of nurses. This includes the organization of TAIEX workshops and many activities within and outside of the RH Ministry of Health and Social Welfare where the Croatian Nurses Association represents a partner and participates in the technical co-organization and the professional activity support.

Two Steering Committee meetings will be held for the purpose of reviewing the progress made under the project as well as to discuss results achieved and/or problems occurred. The first Steering Committee meeting will be held during the third month of project activities implementation in order to discuss and comment the draft start-up report. The second Steering Committee meeting will be organised during the last month of the implementation period to discuss the draft final report.

It should be noted that the participation of the Member State Project Leader in Steering Committees meetings have to be combined with expert missions, in case the Member State Project Leader is also a short- term expert in the twinning light project. If the Member State Project Leader is not short-term expert in the twinning light project then his visits to Croatia, (one visit every three months) as part of his overall task to ensure coordination and political steering of the project, should be organised at the same time as the two Steering Committee meetings of the project.

The exact participants of the Steering Committee meetings will be defined during the implementation of the project, but will at least include the following members:

 BC Project Leader  MS Project Leader  CFCA Project Manager  EUD Task Manager  CODEF Sector Manager  Representatives of the: - Ministry of Health and Social Welfare - Ministry of Science, Education and Sports - Agency for Science and Higher Education - Agency for Vocational Education and Training - University of Rijeka, School of Medicine - School for Nurses Mlinarska - Croatian Nurses Association

- 15 - The beneficiary is committed to provide all necessary infrastructure such as office space and desktop computers with internet connection for experts, venue for holding seminars and workshops, and to ensure the necessary local staff/experts inputs.

5. Budget

The maximum total budget for the project is 230.000 EUR.

Interpretation costs will be reimbursed from the budget only for the purpose of workshops and seminars, up to 7% of the budget can be used for translation and interpretation purposes.

Provisions for visibility costs and expenditure verification costs should be included in the budget.

6. Implementation Arrangements 6.1 Implementing Agency responsible for tendering, contracting and accounting

Central Finance and Contracting Agency (CFCA) Ulica grada Vukovara 284 HR – 10000 Zagreb Mrs. Marija Tufekčić, Director of the CFCA Phone:+ 385 1 4591 245 Fax: +385 1 4591 075 E-mail: [email protected]

Twinning Administrative Office Central Finance and Contracting Agency Ulica grada Vukovara 284 HR - 10000 Zagreb Contact: Mr Domagoj Šimunović Phone: +385 1 4591 213 Fax: + 385 1 4591 075 E-mail: [email protected]

6.2 Main counterpart in the BC

The Senior Programme Officer (SPO) for the project is:

Mr Ante - Zvonimir Golem, State Secretary Ministry of Health and Social Welfare (MHSW) Ksaver 200 a 10 000 Zagreb Phone: +385 1 4677 100 Fax: +385 1 4677 101 E-mail address: [email protected]

- 16 - BC Project Leader

Ms. Dubravka Matijašić-Bodalec Ministry of Health and Social Welfare Ksaver 200a HR - 10 000 Zagreb, Republic of Croatia Tel: 00 385 1 46 07 576 Fax: 00 385 1 46 07 577 E-mail: [email protected]

Mrs. Helena Purgarić Croatian Nurses Association Sortina 1a HR – 10000 Zagreb, Republic of Croatia Tel: 00 385 1 65 50 366 Fax: 00 385 1 65 50 366 E-mail: [email protected]

6.3 Contracts

It is envisaged that the Project will be implemented thorough one Twinning light contract, with an indicative amount of 230.000 EUR.

6.4 Reporting

The Start-up Report will cover first two months of the contract and will be submitted during the third month. The Start-up report should: - Clearly define the aims and purpose of the aid provided by the project, - Give detailed description of the content of particular parts of the project, - Work out in detail the activities carried out and the results achieved, - Work out in detail all modifications agreed with the beneficiary institution, - Review difficulties met during the implementation of the project and measures that were undertaken for their removal, - Provide all findings obtained in the meanwhile and preliminary conclusions, and - Contain a general plan of activities for the implementation of the remained duration of the project.

The Final Report shall be submitted within three months upon the completion of the project activities and in any case within the legal duration of the project, and it should contain the following: - Complete review of all activities carried out by MS experts during the implementation of the project, - Achieved progress concerning each activity, - Summary of all project results, with particular emphasis on mandatory results, - Estimation of the project impact compared with the project aims and measures of the achieved progress, - Identification of all important problems met during the implementation of the contract and solutions that have been applied, - Lessons drawn from the project, and - Recommendations for further steps in future projects

- 17 - Reports shall be submitted to Ministry of Health and Social Welfare, the Central Finance and Contracting Agency, Central State Office for Development Strategy and Coordination of EU funds and the EU Delegation in Croatia in a form of 4 hard copies and an electronic version. All reports should be written in English.

6.4 Language

English will be the working language of the TWL project.

7. Implementation Schedule (indicative) 7.1 Launching of the call for proposals: 1Q 2010 7.2 Start of project activities: 3Q 2010 7.3 Project completion: 1Q 2011 7.4 Duration of the implementation period: 9 months, 6 months for the implementation of the activities and 3 months for the starting-up and closure of the Action.

8. Sustainability

Within the framework of the VET reform in the Croatia, VET development Strategy (adopted on the session of Government of the Republic of Croatia on 31 July 2008) and VET Act (Official Gazette 30/09) have given legal framework for mutual recognition of qualifications. Furthermore, Law on Regulated Professions and Recognition of Foreign Professional Qualifications (Official Gazette 124/2009), and Healthcare Strategy (Official Gazette 72/06) that were adopted with the aim of adjustment of education and competences of nurses and midwifes with the regulations of the Directive 2005/36/EC. Preparations for the development national curriculum for nurses in the cooperation with Agency for Vocational Educational and Training (AVET) that is not going to be included in the realization bridging programme for nurses, as well as adjustment of higher education curriculum for midwifes at University of Rijeka is underway. All adjustments are necessary to reach benchmarks necessary for the successful closure of Chapter 3 of negotiation process.

After the end of the project both, regular training programmes and bridging curricula will be applied to the Croatian education system providing that from that moment on, nurses and midwives will have the education and the competences compliant with the requirements of the Directive 2005/36/EC. Consequently, Croatian midwives and nurses will be competent on the EU internal market, and will be able to accomplish their rights regarding the free movement of services. At the same time the requirement of the full transposition and implementation of the acquis of this part of Chapter 3 will be provided for. Completion of this project will enable the beginning of the phase where the implementation of the bridging programmes will start. In accordance with guidelines in parallel with the bridging programmes the trainings of trainers will start, enabling the Croatian system to educate nurses and midwives in line with the Directive requirements, up-grading thereby the quality of the Croatian health-care system.

9. Crosscutting issues (equal opportunity, environment, etc…)

Based on the fundamental principles of promoting equality and combating discrimination, participation in the project will be guaranteed on the basis of equal access regardless of sex, racial or ethnic origin, religion or belief, disability, age or sexual orientation.

In development of modernized curricula for nurses and midwifes, special attention will be given to persons with special needs as well to the principle of equal opportunity for all genders.

- 18 - 10. Conditionality and sequencing

N/A

- 19 - ANNEXES TO PROJECT FICHE a. Logical framework matrix in standard format b. List of relevant Laws and Regulations

- 20 - A) LOGICAL FRAMEWORK MATRIX

Rising the knowledge and skills of nurses and midwives and harmonizing Programme name and number [Cris number] educational curricula with Directive 2005/36/EC IPA 2008 Ministry of Health and Social Welfare Contracting period expires: Disbursement period expires:

Total budget: EUR 230.000 IPA budget: EUR 207.000 Overall objective Objectively Verifiable Indicators Sources of Verification Alignment with the Acquis -MHSW researches and databases Communitaire in the relevant Share (%) of nurses and midwifes whose -Annual report/statistics of MHSW field of nursery and midwives in qualifications have been aligned with Directive and other relevant agencies / Republic of Croatia 2005/36/EC institutions

Project purpose Objectively Verifiable Indicators Sources of Verification Assumptions Modernization of educational curricula - Curriculum for nurses and midwifes prepared -Start up project report for the nurses and midwives and and approved until 2011. -Curricula for nurses and midwives compensating the difference in -Bridging programme prepared www.mzos.hr competences with Directive 2005/36/EC -Bridging programs for nurses and through bridging programmes midwifes www.mzos.hr -Final report

Results Objectively Verifiable Indicators Sources of Verification Assumptions - Increased knowledge for new - Start up report Result 1. curriculum preparation by the end of - Meeting minutes Good project cooperation by MS experts Current educational curriculum for the project implementation - Reports from study and Croatian Experts training of nurses analysed as well as - Working groups established programme insight and acquired knowledge in - 10 participants familiarised with - List of participant of final Qualified and experienced MS experts in current curriculum for the training of nursing education in member state conference the area of analysis of curricula for nurses nurses harmonised with the Directive (study visit) - Bridging programme and midwifes and implementation of 2005/36/EC document Directive 2005/36/EZ - Recommendations - Final report Respective authorities and institutions have sufficient capacities and are willing to cooperate on the issues linked to Result 2. - Analysis of existing competences of implementation Bridging programme I for the nurses nurses and its comparison with

(with less than three-years work Directive 2005/36/EC delivered experience and completed secondary - Bridging programs for nurses education enrolled before academic developed year 2010/2011) and bridging - Draft curriculum for the midwives programme II for the nurses who prepared, entered secondary education prior to academic year 2010/2011) developed

Result 3. - Remarks to the current educational Current educational curriculum curriculum for midwives drafted. (currently offered by Rijeka - Recommendations for possible University) for midwives analysed changes compiled. and recommendations for possible - 6 participants familiarised with changes prepared. midwifery education in member state (study visit)

Result 4. Competences for the midwives analysed and recommendations for possible changes prepared. - Analysis and recommendations Result 5. prepared. Basic educational materials (hand outs) for future educators/instructors who will in the future be responsible for - Number of materials prepared and education of trainers that will teach printed) (directions, recommendations, obstacles, etc.) on curriculum and bridging programs prepared and consolidated. - Final conference organized

Activities Means Specification of costs Assumptions Activities related to result 1. Analysis Twinning light contract EUR 230.000 of educational curriculum for nurses 1.1. Conducting analysis of the current Good project cooperation by MS experts - analysis educational curriculum for nurses which and Croatian experts is being developed and implemented in - round table discussion academic year 2010/2011 Stakeholders correctly identified and fully involved 1.2. Organising and conducting study visits (5 working days, 10 participants) to a relevant EU member state for - study visit working group members and other relevant stake-holders.

Activity related to result 2: Preparation of bridging programme I. and II. for the nurses 2.1 Conducting analysis of existing - analysis competences of nurses and its comparison with the Directive 2005/36/EC 2.2 Preparation of bridging programme I (modules, (theory) exam, checks of - preparation of documentation skills etc.) in order to equalize nurse competences with the Directive 2005/36/EC. (for nurses with less than three years work experience and completed secondary school education enrolled before academic year 2010/2011, and finished internship and - analysis state examination) 2.3 Conducting the comparison of curriculum from academic year 2009/2010 to the one which is in line with Directive and in practice in - Analysis academic year 2010/2011 and analysis and comparison of competences that result after the completion of two above mentioned curriculums. 2.4 Preparation of bridging programme - preparation of documentation II (modules, (theory) exam, checks of skills (practical exams) etc.) in order to equalize competences of nurses with - round table discussion the Directive 2005/36/EC. (for nurses who entered secondary school and are in the process of education before academic year 2010/2011)

Activity related to result 3: Analysis of curriculum for the midwifes - analysis 3.1 Conducting analysis of current educational curriculum for midwives and its comparison with the Directive 2005/36/EC - preparation of documentation 3.2. Preparation of recommendations for possible changes (modules, theory, - preparation of documentation checks of skills (practical exams) etc) 3.3. Organization of a study visit (5 working days, 6 participants) to the - study visit learning institution in the EU Member States.

Activity related to result 4: Analysis of competences for the midwives 4.1 Conducting analysis of existing - analysis prepared competences of midwives and its comparison with the Directive 2005/36/ EC. 4.2 Preparation of recommendations - list of recommendations prepared for possible changes. Activity related to result 5: Preparation of basic educational materials for new curriculum and bridging programs 5.1. Preparation and consolidation of - preparation of documentation. basic educational materials (hand outs, copies) on curriculum and bridging programs resulted from all of the previous activities.

Preconditions b. List of relevant Laws and Regulations

- Zakon o reguliranim profesijama i priznavanju inozemnih stručnih kvalifikacija (Narodne Novine 124/2009, 16 Listopad 2009) (Law on Regulated Professions and Recognition of Foreign Professional Qualifications (Official Gazette No. 124/2009 dated 16 October 2009 –) translation available upon request.

- Education plans and framework programmes for the Health sector:

Data presented in the table according to the official document: "Education plans and framework programmes for the Health sector" published by the Ministry of Science Education and Sports Training program for nurses responsible for Name of the subject in English general care in hours No. Name of the subject in Croatian (the ones set in the Directive Theoretical Clinical instruction 2005/36/EC Annex V.II. given in red) instruction Exercise Practice GENERAL SUBJECTS 1 Hrvatski jezik Croatian Language 548 2 Strani jezik Foreign Language 274 3 Povijest History 297 4 Vjeronauk/Etika Nature and ethics of the profession 140 Social and health legislation 5 Politika i gospodarstvo 32 Principles of administration 6 Zemljopis Geography 105 7 Tjelesna i zdravstvena kultura Fitness and health education 274 8 Matematika Mathematics 140 Biophysics, biochemistry and radiology 9 Fizika 140 (basic physics and biophysics) Biophysics, biochemistry and radiology 10 Kemija i biokemija 70 (basic chemistry and biochemistry) 11 Biologija (s genetikom) Biology (with Genetics) 140 12 Računalstvo Informatics 70 VOCATIONAL NURSING SUBJECTS 13a Zdravstvena njega I General principles of health and nursing 140 35

13b Zdravstvena njega II General principles of health and nursing 70 20 120

13c Zdravstvena njega: Nursing care in relation to: 13c1 interni bolesnici General and specialist medicine 71 95 13c2 psihijatrijski bolesnici Mental health and psychiatry 15 16 General and specialist medicine 13c3 neurološki bolesnici 17 20 (neurological illness) General and specialist medicine 13c4 infektivni bolesnici 17 20 (infection illness) 13c5 zdravo i bolesno dijete Child care and paediatrics 35+31 20 60 13c6 starije osobe Care of the old and geriatrics 20 13c7 kirurški bolesnici General and specialist surgery 31 60 13c8 porodništvo i ginekologija Maternity care 16 16 General and specialist medicine 13c9 Onkološki bolesnici General and specialist surgery 15 20 (oncology illness) Nursing care in dermatology, Bolesti osjetila (ORL, kožne 13c10 othorynolaryngology and 36 bolesti, očne bolesti) ophthalmology 14 Latinski jezik Latin Language 140 15 Anatomija i fiziologija Anatomy and Physiology 105 16 Patologija i patofiziologija Pathology 70 Medicinska mikrobiologija s 17 Bacteriology, virology and parasitology 60 10 epidemiologijom Clinical medicine in relation to nursing 18 Klinička medicina: care in: 18a interne bolesti General and specialist medicine 53 General and specialist medicine 18b infektivne bolesti 35 (infection illness) General and specialist medicine 18c bolesti živčanog sustava 17 (neurological illness) 18d kirurgija General and specialist surgery 31 18e pedijatrija Child care and paediatrics 31 18f ginekologija i porodništvo Maternity care 31 18g psihijatrija Mental care and psychiatry 31

Nursing care in dermatology, 18h bolesti osjetila 30 othorynolarygology and ophthalmology

19 Farmakologija Pharmacology 35 Socijalna medicina, zdravlje i Hygiene: preventive medicine 20 62 okoliš Social and health legislation 21 Zdravstvena psihologija Psychology 70 22 Pedagogija Principles of teaching 70 23 Hitni medicinski postupci Urgent medical procedures 32 32 24 Metodika zdravstvenog odgoja Hygiene: Health education 32 32 Ljetna stručna praksa nakon III Summer practice after 3rd High school 25 razreda pod nadzorom year, in hospital under supervision of 80 mentora u bolnici the High school teacher Stručna praksa za izradu Practice in relation to the vocational 26 završnog ispita - odnosi se na exam – in relation to the topic of the 40 temu završnog ispita vocational exam

VOCATIONAL EXAM (MATURA in Croatia) NURSE ENTERS THE NURSES REGISTER BUT CANNOT ENTER AND EXERCISE PROFESSION INDEPENDENTLY

CLINICAL NURSING INSTRUCTION (INTERNSHIP in Croatia)

ZDRAVSTVENA NJEGA U BOLNIČKOJ DJELATNOSTI / HOSPITAL NURSING CARE Zdravstvena njega General and specialist medicine 27 120 360 internističkih bolesnika (internist patients) Zdravstvena njega kirurških 28 General and specialist surgery 120 360 bolesnika Zdravstvena njega kod General and specialist medicine 29 40 120 infektivnih bolesti (infective diseases) Zdravstvena njega bolesnika u 30 Maternity care 40 120 ginekologiji i porodništvu 31 Zdravstvena njega u pedijatriji Child care and paediatrics (paediatrics) 40 120 Zdravstvena njega u General and specialist medicine 32 20 60 neurologiji (neurological nursing care) 33 Zdravstvena njega u psihijatriji Mental care and psychiatry 20 60 ZDRAVSTVENA NJEGA U IZVANBOLNIČKOJ DJELATNOSTI / OUT-OF-HOSPITAL NURSING CARE Djelatnost patronaže i kućne 34 Home nursing 40 120 njege Zdravstvena njega u Child care and paediatrics (pre-school 35 djelatnosti zaštite predškolske 10 30 child) djece Zdravstvena njega u Child care and paediatrics (school-age 36 djelatnosti zaštite školske 10 30 child) djece Zdravstvena njega u Maternity and nursing care in health 37 djelatnosti za zaštitu zdravlja 10 30 prevention for women žene Zdravstvena njega u General and specialist medicine 38 10 30 djelatnosti opće medicine (general medicine)

STATE EXAM FINAL EXAM THAT ALLOWS THE PROFESSIONAL GC NURSE TO ENTER AND EXERCISE PROFESSION INDEPENDENTLY Exam consists of general and vocational part. General part deals with legal matters (laws governing health sector) and vocational part deals with whole of the GC Nurses program including the Internship.

TOTAL: 2073 117 2013 TOTAL: 3829 423 2043

TOTAL: 4203

TOTAL: 6296