Public Health Education in Montenegro

WP1. ANALYSIS AND ROADMAPING: PUBLIC HEALTH EDUCATION IN MONTENEGRO

DELIVERABLE 1.2‘Analysis of EU practice for public healtheducation’

Published on:11/07/2017

Authors:

Prof. Dr. John Mantas, Health Info Lab, Dept. Of Public Health, University of Athens, Greece Katia Kolokathi, Health Info Lab,Dept. Of Public Health, University of Athens, Greece

Prof. Dr Ramo Sendelj, University of Donja Gorica, Montenegro Prof. Dr Milica Vukotic, University of Donja Gorica,Montenegro Prof. Dr Maja Drakic Grgur, University of Donja Gorica, Montenegro Assist.Prof.Dr Ivana Ognjanovic, University of Donja Gorica, Montenegro Boris Bastijancic,University of Donja Gorica, Montenegro

Prof. Dr. Elske Ammenwerth, UMIT, Austria

Prof. Dr Róza Ádany, DSc, Faculty of Public Health, University of Debrecen, Hungary Prof. Dr. Orsolya Varga, Faculty of Public Health, University of Debrecen, Hungary

Doc. dr Anđela Jakšić Stojanović, Mediterranean University, Montenegro Doc. dr. Danilo Ćupić, Mediterranean University,Montenegro Prof. dr Jelena Žugić,Mediterranean University,Montenegro Doc. dr Dragica Žugić, Mediterranean University, Montenegro

Prof. Dr. Petra Knaup, Inst. of Med Biometry and Informatics, University of Heidelberg Max Seitz,Inst. of Med Biometry and Informatics, University of Heidelberg, Germany

Prof. dr Goran Nikolic, Faculty of Medicine, University of Montenegro

Prof.dr Dragan Đurić, Institute of Modern Technology Montenegro Bojana Tošić, Institute of Modern Technology Montenegro

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

This project has been funded with support from the European | http://www.udg.edu.me | [email protected] Commission. This publication [communication] reflects the views only of the | Tel:+382(0)20 410 777 author, and the Commission cannot be held responsible for any use | Fax:+382(0)20 410 766 which may be made of the information contained therein. | PROJECT WEBSITE:www.ph-elim.net

Table of Contents

WP1

Task 1.2 Analysis of EU practice for public health education

Deliverable 1.2

Contents 1. Introduction ...... 5 1.1 Definitions ...... 5 1.2 Historical Aspects ...... 7 2. Educational Systems ...... 9 2.1 University Education ...... 11 2.2 Continuing and Life-long Learning ...... 13 2.3 Professional Education and Certification ...... 14 3. International Public Health Educational Strategies, Best Practices, and Frameworks ... 14 4. Public Health Education in EU Countries ...... 25 4.1 Austria ...... 25 4.2 Belgium ...... 30 4.3 Bulgaria...... 33 4.4 Croatia ...... 37 4.5 Cyprus ...... 41 4.6 Czech Republic ...... 53 4.7 Denmark ...... 57 4.8 Estonia ...... 68 4.9 Finland ...... 76 4.10 France ...... 81 4.11 Germany ...... 88 4.12 Greece ...... 104 4.13 Hungary ...... 113 4.14 Ireland ...... 116

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.15 Italy ...... 123 4.16 Latvia ...... 133 4.17 Lithuania ...... 149 4.18 Luxemburg ...... 172 4.19 Malta ...... 174 4.20 Netherlands ...... 178 4.21 Poland ...... 186 4.22 Portugal ...... 202 4.23 Romania ...... 201 4.24 Slovakia ...... 228 4.25 Slovenia ...... 234 4.26 Spain ...... 238 4.27 Sweden ...... 242 4.28 United Kingdom...... 251 5. Public Health Education Best Practices in other Countries ...... 254 5.1 Australia ...... 254 5.2 Canada ...... 261 5.3 Japan ...... 271 5.4 USA ...... 279 6. Conclusions ...... 285 References ......

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

1. Introduction

This report provides an overview of public health educational practices in EU and other countries. The report commences with definitions of the domain of public health and proceeds with brief historical aspects of public health education. Furthermore, it collects country descriptions on the basis of educational system organisation and existing programmes in public health. These country descriptions will provide the way to compare and collect best practices in assisting the authorities of Montenegro to select and compare practices in EU and elsewhere with their own practices in Public Health Education. 1.1 Definitions

Education and training of public health professionals is available throughout the world in Schools of Public Health, Medical Schools, Veterinary Schools, Schools of Nursing, and Schools of Public Affairs. The training typically requires a university degree with a focus on core disciplines of biostatistics, epidemiology, health services administration, health policy, health education, behavioral science and environmental health. In the global context, the field of public health education has evolved enormously in recent decades, supported by institutions such as the World Health Organization and the World Bank, among others. Operational structures are formulated by strategic principles, with educational and career pathways guided by competency frameworks, all requiring modulation according to local, national and global realities. It is critically important for the health of populations that nations assess their public health human resource needs and develop their ability to deliver this capacity, and not depend on other countries to supply it. Schools of public health offer a variety of degrees which generally fall into two categories: professional or academic. The two major postgraduate degrees are the Master of Public Health (M.P.H.) or the Master of Science in Public Health (MSPH). Doctoral studies in this field include Doctor of Public Health (DrPH) and Doctor of Philosophy (Ph.D.) in a subspeciality of greater Public Health disciplines. DrPH is regarded as a professional degree and Ph.D. as more of an academic degree.

Professional degrees are oriented towards practice in public health settings. The Master of Public Health, Doctor of Public Health, Doctor of Health Science (DHSc) and the Master of Health Care Administration are examples of degrees which are geared towards people who want careers as practitioners of public health in health departments, managed care and community-based organizations, hospitals and consulting firms among others. Master of

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Public Health degrees broadly fall into two categories, those that put more emphasis on an understanding of epidemiology and statistics as the scientific basis of public health practice and those that include a more eclectic range of methodologies. A Master of Science of Public Health is similar to an MPH but is considered an academic degree (as opposed to a professional degree) and places more emphasis on scientific methods and research. The same distinction can be made between the DrPH and the DHSc. The DrPH is considered a professional degree and the DHSc is an academic degree. Academic degrees are more oriented towards those with interests in the scientific basis of public health and preventive medicine who wish to pursue careers in research, university teaching in graduate programs, policy analysis and development, and other high-level public health positions. Examples of academic degrees are the Master of Science, Doctor of Philosophy, Doctor of Science (ScD), and Doctor of Health Science (DHSc). The doctoral programs are distinct from the MPH and other professional programs by the addition of advanced coursework and the nature and scope of a dissertation research project. 1.2 Historical Aspects

Graduate education in public health began in the early 1900s and formal accreditation was initiated in the mid-1940s when 10 schools of public health were recognized by the American Public Health Association (APHA), the nation’s largest individual public health membership organization. From 1945 to 1973, APHA carried out accreditation of graduate professional education in public health, at first centered almost exclusively in schools of public health but later including other college and university settings. The history of public health is dynamic and being generated on a constant basis. Diseases have provided the stimulus for much of the activity in public health. In a handful of instances, overcoming a disease has removed a barrier to commerce or another desired goal. For example, overcoming yellow fever facilitated construction of the Panama Canal in the early 1900s, and finding a cure for scurvy allowed mariners to make longer voyages of exploration. It is important to note that advances in public health usually have impacts on people throughout the world and that public health is an international effort. Public health researchers are focusing on heart disease and type 2 diabetes in response to contemporary epidemics. Efforts to understand and cure diseases have had the unintended consequences of developing tools. The science of epidemiology emerged from efforts to stop cholera in England. In addition, forces other than disease have affected public health. Examples include the sanitary movement that began in England and was quickly duplicated in a new

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

England (mid-1800s), social concerns that reformers used to promote mandatory schooling for children as a way to stop child labor in factories (mid-1800s), and concern for wholesome food (late 1800s). A small number of diseases have had a disproportionate impact on the history of public health throughout the world. These include smallpox, influenza, tuberculosis (TB), and HIV/AIDS. The first three diseases have been known since antiquity; HIV/AIDS is a more recent problem. Smallpox is noteworthy for its mortality rate and because it is the only disease that has been eradicated. Influenza became a human disease after individuals domesticated pigs. Because influenza mutates so readily, it continues to challenge public health planners. In periodic pandemics, influenza kills many people. Tuberculosis, like influenza, migrated to humans after cattle were domesticated. TB is a concern for public health for at least two reasons. Experts estimate that one person in three carries the TB pathogen. Because the length of time required to treat TB is long (months), most strains of TB have developed drug resistance. Finally, as of 2010, HIV/AIDS has caused more than 40 million deaths. With the exception of HIV/AIDS, vaccines have been developed for these diseases. The smallpox vaccine provided the means for eradication, whereas influenza mutates so readily that the vaccine must be frequently revised. A vaccine for TB is also available, because it is not effective in all recipients, it is not used in the United States as a matter of public health policy. London School of Hygiene & Tropical Medicine introduced as Seamen's Hospital Society branch hospital opens at the Royal Albert Dock, London on 1890. Sir Ronald Ross discovers the transmission of malaria by mosquitoes in 1892. Sir Aldo Castellani researches trypanosome as the cause of sleeping sickness in 1903.

Health education emerged as a profession in the 1940’s and the development of standards, professional preparation, and associations has evolved over the past several decades. A concern for disparities in health status between Black and White Americans led to the creation of the Health Education program at North Carolina Central University in 1945. The department was developed as a separate academic department by Dr. James E. Shepard, founder of the University, with the assistance of Dr. Milton Rosenau, a pioneer in the field of public health and director of the School of Public Health at UNCCH. At that time, Dr. Shepard’s goal was to prepare black public health workers for the Southern region of the United States, and he initially organized a graduate program in health education leading to the Master of Science in Public Health.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

2. Educational Systems

Education systems vary a lot between countries. International data on education should therefore be based on a classification which proposes, for all countries of the world, sound criteria for the allocation of education programmes to levels which can be considered as comparable. The International Standard Classification of Education (ISCED) is such a statistical framework for organizing information on education maintained by the United Nations Educational, Scientific and Cultural Organization (UNESCO). ISCED described the following nine levels of education:

Table 2.1.

Early childhood Education (01 Education designed to support early development in Early childhood educational preparation for participation in school and society.

development) Programmes designed for children below the age of 3. Early childhood Education (02 Education designed to support early development in Pre-primary education) preparation for participation in school and society. Programmes designed for children from age 3 to the start of primary education. Primary education Programmes typically designed to provide students with fundamental skills in reading, writing and mathematics and to establish a solid foundation for learning. Lower secondary education First stage of secondary education building on primary education, typically with a more subject- oriented curriculum. Upper secondary education Second/final stage of secondary education preparing for tertiary education and/or providing skills relevant to employment. Usually with an increased range of subject options and streams

Post-secondary non-tertiary Programmes providing learning experiences that education build on secondary education and prepare for labour market entry and/or tertiary education. The content is broader than secondary but not as complex as tertiary education.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Short-cycle tertiary education Short first tertiary programmes that are typically practically-based, occupationally-specific and prepare for labour market entry. These programmes may also provide a pathway to other tertiary programmes. Bachelor or equivalent Programmes designed to provide intermediate academic and/or professional knowledge, skills and competencies leading to a first tertiary degree or equivalent qualification.

Master or equivalent Programmes designed to provide advanced academic and/or professional knowledge, skills and competencies leading to a second tertiary degree or equivalent qualification.

Doctoral or equivalent Programmes designed primarily to lead to an advanced research qualification, usually concluding with the submission and defense of a substantive dissertation of publishable quality based on original research.

2.1 University Education

The Bologna Process is a series of ministerial meetings and agreements between European countries to ensure comparability in the standards and quality of higher-education qualifications. The process has created the European Higher Education Area under the Lisbon Recognition Convention. It is named after the University of Bologna, where the Bologna declaration was signed by education ministers from 29 European countries in 1999. The basic framework is three cycles of higher-education qualifications. The framework[12] adopted by the ministers at their meeting in Bergen in 2005 defines the qualifications in terms of learning outcomes: statements of what students know and can do on completing their degrees. In describing the cycles, the framework uses the European Credit Transfer and Accumulation System (ECTS):

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 First cycle: typically 180–240 ECTS credits (a minimum of 60 credits per academic year), usually awarding a bachelor's degree. The European Higher Education Area did not introduce the bachelor-with-honours programme, which allows graduates to receive a "BA hons." degree (for example, in the UK, Australia and Canada) which (in the UK and Australia) may enable graduates to begin doctoral studies without first obtaining a master's degree.

 Second cycle: typically 90–120 ECTS credits (a minimum of 60 ECTS per academic year), usually awarding a master's degree

 Third cycle (doctoral degree): There is no concrete ECTS range, since the disciplines vary in length and comprehensiveness.

In most cases, it would take three to four years to earn a bachelor's degree and another one or two years for a master's degree. Doctoral degrees usually require another two to four years of specialization, primarily individual research under a mentor. Degree names may vary by country. One academic year corresponds to 60 ECTS credits, equivalent to 1,500– 1,800 hours of study.

In 2006, the typical age for entering higher education ranged from 18 to 20 years in the Bologna Area. Overall, the net entry rate for this age group was 33 % in the EU-27, meaning that one third of the population aged between 18 and 20 is expected to enter higher education. The net entry rate for this age group was higher than 32 % in half of the Bologna countries for which data are available. In contrast, people over 25 rarely embark on higher education. With the exception of some Nordic countries (Finland, Sweden and Iceland), net entry rates by age were below 2 % for those aged 25 or over. This suggests that the share of students who enter higher education following a prolonged interval between secondary schooling and university entry is rather low across the European Higher Education Area. The demographic structure of the population entering higher education did not present any major changes between 2002 and 2006.

Bachelor’s, Master’s and Doctoral levels of tertiary education are found in all EU Member States, while short-cycle tertiary education, which are typically practically-based and occupationally-specific to prepare students for the labour market, is not part of the education system in Bulgaria, Estonia, Greece, Lithuania, Portugal and Romania, nor in Liechtenstein or the former Yugoslav Republic of Macedonia. It is also quite uncommon in several others, for example in Germany.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

In the EU-28 there were 19.6 million tertiary education students in 2013, of which 7.5 % were following short-cycle tertiary courses, 60.7 % were studying for Bachelor’s degrees, 28.1 % for Master’s degrees and 3.7 % for Doctoral degrees. Short-cycle tertiary courses were most common in France and Ireland where they accounted for more than one fifth of all tertiary students and were also relatively common in Malta, Latvia, Austria and Spain where they accounted for a share between 18 % and 20 %. In Turkey, short-cycle tertiary courses were even more common as almost one third (30.7 %) of all tertiary students were enrolled in such courses. Approximately 4.8 million students graduated from tertiary education establishments in the EU-28 in 2013. 2.2 Continuing and Life-long Learning

Lifelong learning encompasses all purposeful learning activity, whether formal, non-formal or informal, undertaken on an ongoing basis with the aim of improving knowledge, skills and competence. The intention or aim to learn is the critical point that distinguishes these activities from non-learning activities, such as cultural or sporting activities. Lifelong learning can take place in a variety of environments, both inside and outside formal education and training systems. Lifelong learning implies investing in people and knowledge; promoting the acquisition of basic skills, including digital literacy and broadening opportunities for innovative, more flexible forms of learning. The aim is to provide people of all ages with equal and open access to high-quality learning opportunities, and to a variety of learning experiences.

The strategic framework for European cooperation in education and training adopted in May 2009 sets a number of benchmarks to be achieved by 2020, including one for lifelong learning, namely that an average of at least 15 % of adults aged 25 to 64 years old should participate in lifelong learning. In 2015, the proportion of persons aged 25 to 64 in the EU- 28 who participated in education or training was 10.7 %; a share that was 1.4 percentage points higher than the corresponding share for 2010. 2.3 Professional Education and Certification

Professional certification, trade certification, or professional designation, often called simply certification or qualification, is a designation earned by a person to assure

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

qualification to perform a job or task. Certifications are earned from a professional society, university, a certification body, or from a private certifier, for some specific certifications.

Many universities grant professional certificates as an award for the completion of an educational program. The curriculum of a professional certificate is most often in a focused subject matter. Many professional certificates have the same curriculum as master's degrees in the same subject. Many other professional certificates offer the same courses as master's degrees in the same subject, but require the student to take fewer total courses to complete the program. The recognition of professional qualifications laid down in Directive 2005/36/EC enables the free movement of professionals such as doctors or architects within the EU. Other professions such as sailors or aircraft controllers do not fall under Directive 2005/36/EC and are governed by specific legislation. Special laws also exist for lawyers and commercial agents. 3. International Public Health Educational Strategies, Best Practices, and Frameworks

Health education forms an important part of the health promotion activities currently occurring in different countries1, and that is a reason why several organizations highlights objectives related to educational approaches within their strategies. In many cases, listed strategies are regarding health education in general but directly applicable to public health education, as follows:

 UNESCO STRATEGY ON EDUCATION FOR HEALTH AND WELL-BEING: CONTRIBUTING TO THE SUSTAINABLE DEVELOPMENT GOALS2 which reflect growing international recognition of the inter-relationship between education and health. This strategy putscommitment to ensuring all young people have access to comprehensive sexuality education, healthy learning environments, and to the information needed to protect them from HIV and develop healthy relationships.

1http://applications.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf 2http://unesdoc.unesco.org/images/0024/002464/246453e.pdf | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 WHO: Health education: theoretical concepts, effective strategies and core competencies3- The strategy identifies the components of evidence-based health education and outlines the abilities necessary to engage in effective practice. The educational activities occur in schools, workplaces, clinics and communities and include topics such as healthy eating, physical activity, tobacco use prevention, mental health, HIV/AIDS prevention and safety. Health promotion is defined by the Ottawa Charter as the process of enabling people to increase control over and to improve their health. For the purposes of this document, health promotion is viewed as a combination of health education activities and the adoption of healthy public policies. Furthermore, the document gives overview of key components that appear to be essential to effective community-based health education and prevention strategies include the following: (i) Participant involvement- community members should be involved in all phases of a programme’s development: identifying community needs, enlisting the aid of community organizations, planning and implementing programme activities and evaluating results. (ii) Planning- identifying the public health problems in the community, formulating goals, identifying target behaviour and environmental characteristics, deciding how stakeholders will be involved and building a cohesive planning group. (iii) Needs and resources assessment- Prior to implementing a public health education initiative, it is essential to identify the health needs and capacities of the community and the resources that are available. (iv) Comprehensive programme- development of educational programme best suiting to identified needs and available resources

(v) Integrated programme - The programme should be integrated; each component of the programme should reinforce the other components. (vi) Long-term change- Health education programmes should be designed to produce stable and lasting changes in health behaviour.

3http://applications.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

(vii) Altering community norms- Health education programme must be able to alter community or organizational norms and standards of behaviour.

(viii) Research and evaluation- It is needed in order to assess and describe its formation and process, and its cost-effectiveness and benefits.

As authors stated in 4 , some networks within health and public health community are searching to define SMART objectives (specific, measurable, achievable, relevant, and time- bounded objectives). This is visible in their actual predominant activities: during some of the time, education and training are dominant, and at other times research activities or public health interventions are. Regarding the scope of education for global health, it is an achievement that networks in public health are dealing with development of global health competences (‘Global Health is Public Health’), sometimes for varying groups of health professionals, (e.g. EAGHA5). The sub-committee for health education published “Global Health Education Declaration 1.0” that is built upon students' at meetings in Copenhagen and Berlin. One of key elements in the Declaration are recommendations and suggestions regarding health education, as follows:

 Integration of the scientifically oriented human health model with a deeper knowledge of the global and social determinants of health;

 Focus on capabilities to manage complexity and uncertainty, critical thinking and reflection; synthesise and application of evidence from a wide range of disciplines

 Increase emphasis on teamwork, advocacy, agency, entrepreneurship and engagement with civil society;

 Involving role models so students understand global health career opportunities;

 Educational methods appropriate for Global Health: o Core curriculum: apply transformative methods to the core curriculum that actively engage the learner and increase their sense of agency, social

4https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925808/ 5http://eagha.g2hp.net/

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

responsibility and leadership skills; link education on global health with research; etc.

o Optional or elective curriculum: expand optional opportunities such as local and international peer tutoring joint learning across academic and clinical disciplines, working with voluntary and civil society groups, and exploring art and literature; develop links with international students and agencies via a virtual learning environment and social networks; etc. o Assessments: use assessments that are consistent with the learning outcomes for global health such as integrated clinical simulations, portfolios with written reflections, case studies of international electives, group projects and presentations. Finally, ASPHER- ASSOCIATION OF SCHOOLS OF PUBLIC HEALTH IN THE EUROPEAN REGION published Strategic Plan 2016-20206, which is developed upon strategic objectives specifying ASPHER’s core mission within “education and training for research and service” (as agreed in May 2014). Strategic objectives related to public helath education are the following: Strategic objective 1. Improving quality of academic programmes and continuing professional development (CPD) for public health; Strategic objective 3. Setting up a public health profession for public health services in Europe; Strategic objective 4. Developing the global dimension of education and training for public health. Strategic objective 1: Improving quality of academic programmes and CPD for public health

Sub-objectives: 1.1. Promote harmonization of high quality education and training for public health: develop and pilot model curricula, advocate and implement as standard for all European schools of public health, and evaluate public health education and training programmes at all three Bologna levels;

Vision following specific objective 1.1:

6http://aspher.org/download/21/aspher2020_full-aga2015.pdf | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Europe-wide implementation of standard curricula for public health at all three Bologna levels. Activities:

1.1.1. Assessment of bachelor and doctoral programmes and reassessment of master programmes throughout Europe 1.1.2. Development of quality standards for accreditation of PH programmes

1.1.3. Advocacy for public health programmes following the full Bologna cycle to be offered by all SPHs in Europe 1.1.4. Promotion of European accreditation scheme for PH education 1.2. Enhance continuing professional development (CPD) through blended learning modules offered to all public health professionals by the European school of public health (business model of excellence);

Vision following specific objective 1.2:

 Increase the schools of public health capacity for CPD and assure its high quality. Activities:

1.2.1. Mapping of the available CPD in PH in Europe 1.2.2. Development and pilot of standards for CPD with a focus on blended learning

1.2.3. Popularize a European accreditation for CPD in PH 1.2.4. Advocacy for national schemes/ licensing of CPD in public health

1.3. Increase mobility in the European Higher Education Area (EHEA) and develop joint models for education and training together with the exchange of best practices. Vision following specific objective 1.3:

 Support Europe-wide mobility of students and lecturers in public health

Activities:

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

1.3.1 Pilot criteria for the mutual acknowledgement of modules taken by students in exchange

1.3.2. Facilitating the mobility of students and lecturers 1.3.3. Establishing a database of all PH education and training programmes available in English

Strategic objective 3: Setting up a public health profession for public health services in Europe Sub-objectives:

3.1. Shape a public health profession in European countries by developing a European Public Health Reference Framework (EPHRF) and its online repository for individual career as well as services planning;

Visions following specific objective 3.1:

 Develop tools for individual career and systems human capacity planning based on the relationship between population health challenges, EPHOs and competences.

 Develop European lists of public health core competences for all categories of public health workforce and for all educational and training levels.

 Support the shaping of a professional identity and culture in schools of public health and national associations of public health. Activities:

3.1.1. Revision and further development of ASPHER’s lists of PH core competences by the Council under the European PH Reference Framework

3.1.2. Setting up a pilot for the online tool for individual careers and human capacity systems planning under the European Public Health Reference Framework 3.1.3. Implementing the lists of competences in member SPHs.

3.2. Lead on the work of the WHO Europe’s essential public health operation 7 (EPHO7) working group established under the framework of the European Action Plan on

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Strengthening Public Health Capacities and Services – a key pillar of the overarching regional policy framework, Health 2020, to ensure a sufficient and competent public health workforce in the region; Visions following specific objective 3.2:

 Assess the present human capacity and the capacity needs in public health in WHO European member states regarding all categories of public health workforce.

 Assess the need for development of public health education and training in WHO European member states and give advice to WHO European member states concerning meeting estimated needs for the development of education and training capacity.

Activities: 3.2.1. Development of the EPHO7 toolkit

3.2.2. Advice to WHO Europe member states as indicated above

3.3. Advocate the public health profession based on the code of conduct (professionalisation). Visions following specific objective 3.3:

 Develop and agree on the professionalisation model and its structural and attitudinal attributes with respect to professionalisation of public health workforce.

 Launch a systematic advocacy campaign for public health professionals to influence relevant processes in the area of health workforce planning and development.

 Support the development of national and European professional chambers safeguarding professional regulations and access to the profession.

 Initiate and support the development of the ethical code of conduct for public health professionals.

Activities: 3.3.1. Development of PH professionalisation model

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

3.3.2. Setting up an advocacy group for PH professionals to influence relevant processes in the area of health workforce

3.3.3. Development of guidelines with code of conduct for PH professionals Strategic objective 4: Developing the global dimension of education and training for public health Sub-objectives:

4.1. Develop a model curriculum on global health at the MPH level and an adapted version for CPD, advocate and implement it as standard for all European schools of public health; Visions following specific objective 4.1:

 Develop and test a module on Global Public Health. Activities:

4.1.1. Development of the module format 4.1.2. Testing of the draft module

4.1.3. Promoting the use of the module developed by member SPHs 4.2. Establish a think tank on global and regional health governance focusing on the implementation and evaluation of interventions, within the capacity of the membership network and in partnerships; Visions following specific objective 4.2:

 Increased number, size and quality of schools of public health in Europe and beyond with the support of ASPHER’s ambassador function.

Activities:

4.2.1. Setting up a think tank on global and regional health governance 4.2.2. ASPHER’s amabassadors’ programme

4.3. Investigate the options for a Global ASPHER Alumni Association together with support of alumni’s mobility. | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Visions following specific objective 4.3:

 Develop a Global ASPHER Alumni Association. Activities:

4.3.1. Investigating the options for a Global ASPHER Alumni Association

4.3.2. Supporting member SPHs in setting up alumni networks Also, WHO Europe’s “Strengthening public health capacities and services in Europe: a framework for action”7 (EUR/RC61/Conf.Doc./3) is a stimulus for further strengthening of public health education, research and practice. Similarly to other citied documents, it is highlited that education is one of key activities within health promotion programmes. The documents defines essential public health operations (EPHO) among which, EPHO 8 defines the need for Assuring a competent public health and personal health care workforce, with the following strategic operations related to public health education: B. Standards

B.1 Evaluate your mechanisms for maintaining public health workforce standards (education, certification, and licenses).

B.2 Evaluate your mechanisms for evaluating the public health workforce, including continuous quality improvement and continuing education and training programmes. C. Education and accreditation

C.1 Evaluate the structure of training in public health management. C.2 Evaluate undergraduate programmes in Medicine relevant to public health.

C.3 Evaluate undergraduate programmes in Pharmacy relevant to public health.

C.4 Evaluate undergraduate programmes in Veterinary Medicine relevant to public health. C.5 Evaluate undergraduate programmes in Nursing relevant to public health.

7http://www.euro.who.int/__data/assets/pdf_file/0011/134300/09E_StrengtheningPublicHealthFramework_1104 52_eng.pdf | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

C.6 Evaluate undergraduate programmes in Dentistry relevant to public health. C.7 Evaluate undergraduate programmes in Social Work relevant to public health.

C.8 Evaluate the adequacy of Schools of Public Health.

C.9 Evaluate Master of Public Health Programmes. C.10 Evaluate Master of Health Services administration and/or Policy, Leadership, or Management. C.11 Evaluate other relevant academic programmes related to health protection, promotion or disease prevention (specify).

C.12 Evaluate Quality Control and Accreditation programmes at Undergraduate level. C.13 Evaluate existing Quality Control and Accreditation programmes at Postgraduate level.

Interventions and planning in public health education shall be also rooted in a number of key EU policy documents, e.g.:

 “Strategic framework for European cooperation in education and training – ET 2020” (Official Journal of the European Union 2009; C119/5).

 “The role of education in a fully-functioning knowledge triangle” (Official Journal of the European Union 2009, C302/3).

 “European Universities’ Charter on Lifelong Learning” (EUA, 2008). 4. Public Health Education in EU Countries 4.1 Austria

4.1.1 Educational System

School education is compulsory for nine years and starts at the age of 6. Primary school is the general compulsory school for pupils aged 6-10 (years 1 to 4). The lower secondary level (years 5 to 8) comprises New secondary school (Neue Mittelschule) or Lower level of academic secondary school (Allgemein bildende Höhere Schule). The upper secondary level

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

(years 9 to 13) comprises a general education branch and a vocational branch. Higher education is provided by Public Universities (the biggest sector), Private Universities, Universities of Applied Sciences (Fachhochschulen) that offer science-based vocational training with an emphasis on vocational orientation and University Colleges of Teacher Education (Pädagogische Hochschulen). Adult learning programmes may lead to legally regulated qualifications (also called formal qualifications). Concerning schools responsibilities for legislation and its implementation are divided between the federation (Bund) and the provinces (Bundesländer). Legislation and execution of all matters pertaining to universities and higher education is a federal responsibility. The freedom of scholarship and teaching, and the freedom of art, are guaranteed in constitutional legislation. General government expenditure on education as a proportion of GDP has remained stable over 2011-13 at 5.0%, slightly above the EU average of 4.8% in 201. The total budget allocation for higher education institutions increased from EUR 6.2 billion over the period 2007-09 to EUR 8 billion for the period 2013-15. At the same time student numbers increased from 261 000 in 2007 to 376 500 in 2012.

4.1.2 Public Health Education and Educational Institutions

Training in public health or a related field can be obtained by following different training and career paths. One path is to study medicine and to then specialize in social medicine, occupational medicine or to engage in training at one of the universities offering postgraduate training courses in public health or a related field. Austria has three public medical universities which are located in Vienna, Graz and in Innsbruck and one private medical university in Salzburg. Physicians can also enrol in a postgraduate training course for physicians working in the ÖGD, which is offered at the three public medical universities already mentioned. Other training options (school physician, environmental medicine) are available for physicians in the form of diploma courses.

Another path is to complete an undergraduate course at a university in any subject and then to enrol in a postgraduate public health programme. Individuals may also enrol in a postgraduate programme without having an undergraduate degree if they are able to demonstrate sufficient work experience in public health, sometimes in a leading position.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Several Universities of Applied Sciences offer undergraduate training in subjects such as health promotion and health services management.

It is also possible to enter the public health field without formal graduate or postgraduate training on the basis of extensive practical experience and attendance at conferences, seminars and workshops.

Public health programmes are not well established in Austria. The first Austrian MPH programme started at the University of Graz in the autumn of 2002. More recently, further programmes have been started at the Johannes Kepler University in Linz (Upper Austria), at the UMIT in Hall in Tyrol (a Health Management course), and at the University of Vienna. The curriculum followed in Graz is also offered in Schloss Hofen (Vorarlberg), in cooperation with the University of Applied Sciences in Dornbirn. Various universities (for example, in Krems and Klagenfurt) and Universities of Applied Sciences (for example, in Pinkafeld, Steyr or Bad Gleichenberg) have followed the trend and started courses with public health elements, such as health care management, health promotion and hospital management. Overall,in 2014, three postgraduate programmes and two doctoral programmes exist in Austria (in Vienna and in Hall/Tirol), as well as 34 programmes that partly cover public health topics. One huge problem in public health training, both at university and college levels is a serious shortage of teachers trained in public health.

4.1.3 Expenditure and Economics in Public Health

Public health expenditure, total (% of GDP) of Austria was reported at 8.7% in 2014.

76.4% of total health expenditure was public, while 23.6% was private. Health expenditure on prevention and public health services amounted to €455 million in 2007. The OECD manual a system of health accounts defines this expenditure category as “collective health services covering traditional tasks of public health such as health promotion and disease prevention,including settling and enforcement of standards”. In comparison, €9.272 million was spent on inpatient care and €5.077 million on outpatient care.

In 2004 the then BMGF published a report entitled Public Expenditure on Health Care Prevention and Health Promotion in Austria that was based on 2001 data. The authors stated that public expenditure on health care prevention and health promotion amounted to about 6.3% of total health expenditure and about 9.3% of total public expenditure on

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

health. This is the equivalent of an annual amount of about €127 per person living in Austria and €1.027 billion in total.

4.1.4 Challenges and Future Perspectives

In 2014, the Austrian, “Gesundheitsförderunsstrategie” (health promotion strategy) was published that describes a framework for contributing to longer and healthier life of all people in Austria. The understanding of public health in Austria is variable, not only generally speaking but also within different levels of the health system or even within individual institutions or departments. Legislation on public health issues in Austria is fragmented and in some cases outdated and patchy. No legal definition of public health exists in Austria and there is no Public Health Act. Several public health functions and activities are regulated in a range of legal documents. Public health in Austria is still strongly dominated by the medical profession. Physicians operate either in the clinical setting (in hospitals or private practice), are employed by one of the medical authorities operating at various levels of the health system, or work for health system stakeholders such as social insurance, universities or research institutions. Several work as school or occupational physicians. Nonmedical professionals are gradually moving into the field. However, most of them – particularly nurses – still find it very difficult to enter Master’s programmes relating to public health and to obtain acknowledgement of their further training after graduation, in terms of an extension of duties and/or an increase in salary. Other countries involve nonmedical health professionals to a much greater extent than Austria, where public health, family and community nurses do not actually exist. Since the first postgraduate public health programme was started at the Medical University of Graz in 2002, several other programmes have followed in Vienna, Tyrol and Upper Austria. These have resulted in the formation of a body of about 150–200 national public health professionals, including those who trained abroad. The impact of these professionals is noticeable but a critical mass has yet to be reached.

A recent publication (Diem&Dorner, 2014) proposes that public health programmes should be accredited by the ASPHEA (European Agency for Accreditation in Public Health Education). They also argue that Austrian is far away from a critical mass of public health awareness, and that Austria needs more public health experts.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

A larger number of public health professionals is gradually developing and graduates seem to have no difficulty in finding jobs. A high proportion of graduates remain, at least initially, with their present employer, especially if their training was co-funded. A degree in public health is often perceived as job enrichment, leading not necessarily to a change in job but to an extension of responsibilities within the organization.

There is no definition of the term public health professional in Austria; further, no national strategy or targets for public health education, training or research exist. Career paths are only just developing and lack clarity, structure and coordination. Organizational development is still lagging behind workforce development, and organizations are often unprepared to make the best use of the skills that public health professionals have to offer. Attractive career paths with competitive reimbursement will need to be developed in the public sector in order to keep public health professionals from moving to the private sector or from leaving Austria to work abroad. 4.2 Belgium

4.2.1 Educational System

The compulsory school age in Belgium is six to 18 years. Secondary school progresses through three stages, starting off with general studies in the early years, after which students can specialise in general, vocational, technical, or artistic streams depending on individual choice and ability. Higher education in Belgium is provided by universities, university colleges and government-recognised institutions, although only universities can award PhDs. There are six universities in Belgium which offer a full range of subjects. The higher education system in Belgium follows a Bachelor/Master process with a Bachelor's degree obtained after three years and a Master's degree after a further one or two years. Both universities and colleges can award these degrees.

As Belgium is divided into distinct federal regions there are separate education systems that run along very similar lines for each of the communities. There are three regional Ministries of Education with responsibility for implementing government policy: One for Dutch speaking communities, one for French speaking communities, and one for German speaking communities. Public spending on education, total (% of GDP) in Belgium was reported at 6.4 % in 2011.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.2.2 Public Health Education and Educational Institutions

Several higher education institutions offer programmes in public health. For example, the Institute of Tropical Medicine Antwerp offers a one-year Master in Public Health – International Health. University of Antwerp offers a two-year Master in Epidemiology. Maastricht University offers a one-year Master in European Public Health and a Master in Health Sciences. The UC Leven-Limburg offers a three-month postgraduate certificate in Elderly Care 2.0. Ghent University offers a postgraduate certificate in International Health Care. A specialty in public health for physicians does not seem to exist in Belgium.

The Scientific Institute of Public Health (known as WIV-ISP) is a federal institute that provides support for public health policy through scientific research, expert opinions and divisional tasks. On the basis of scientific research, the WIV-ISP formulates recommendations and solutions in respect of priorities for a proactive health policy at the Belgian, European and international levels.

The Health, Food Chain Safety and Environment FPS is responsible for preparing and implementing strategy for public health (funding care establishments, organising the healthcare professions, providing emergency medical assistance, consultation bodies). It also has the task of preparing and carrying out the strategy relating to food safety and the protection of public health and the environment (standardisation of products, checks on cosmetics and tobacco, animal welfare, sustainable production and consumption).

4.2.3 Expenditure and Economics in Public Health

Public health expenditure, total (% of GDP) of Belgium was reported at 8.2 % in 2014.

4.2.4 Challenges and Future Perspectives

The National Environmental Health Action Plan (NEHAP) of Belgium better harmonizes the complex policy domains of environment and health. The federal government, the regions and the communities together carry out this plan. As announced in 2015, health professionals, such as doctors, nurses, midwives, physiotherapists and others, can in the future obtain a certificate in environmental medicine. During their studies they will receive basic training to this end as well as

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

continuing education in environmental medicine. To this point there has been little to no training provided concerning the impact of the environment on health. Nevertheless, human health often suffers on account of environmental circumstances. By taking this into account, health professionals can make faster and more accurate diagnoses and certain illnesses can be prevented or treated more efficiently. To this point, however, few health workers have been made aware of or trained in environmental medicine or environmental health. But this is going to change in future. Doctors, nurses and other health workers can in future follow basic training and continuing education in environmental medicine and obtain a certificate in environmental medicine. 4.3 Bulgaria

Education in Bulgaria is overseen by the Ministry of Education and Science. Since 2012, compulsory education includes two years of preschool education (usually starting at age 5), before children start primary school. Education is compulsory until age of 16. Education at state-owned schools is free of charge, except for the higher education schools, colleges and universities.

In 1998 enrollment in the primary grades was 93 percent of eligible students, and enrollment in the secondary grades was 81 percent of eligible students. The ratio of females to males in primary schools was 0.97, and the ratio in secondary schools was 0.98. Because of Bulgaria’s low birthrate, total primary- and secondary-school enrollment has decreased in the post-communist era, causing reductions in teaching staff and facilities. At the same time, the number of private schools increased by 10 times during the 1990s. Bulgaria’s higher education system was fully reorganized in the mid-1990s. Between 1995 and 2002, the number of university graduates increased from 33,000 to 50,000. In 2002 some 42 institutions of higher learning were in operation, and 215,700 students were enrolled. In 2003 some 4.9 percent of Bulgaria’s national budget was devoted to education. The types of higher education institutions are Universities, Colleges and Specialized Higher Schools. Universities, as in most countries worldwide, have three stages: Bachelor's (undergraduate), Master's (graduate), and Doctoral degrees. Undergraduate stage lasts for at least four years and graduate stage lasts for five years after completion of secondary education or one year after obtaining a bachelor's degree. The third stage of higher education results in obtaining a Ph.D. Degree. Specialized higher schools offer degrees in one or more areas of science, arts, sports, and defense. Usually, the names of these

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

institutions indicate the area of specialization. Colleges are former semi-higher institutes. Some of them are part of universities and use their equipment and facilities.

The medical universities, consisting of the Medical Universities of Sofia, Varnaand Plovdiv and the Medical Schools in Pleven and Stara Zagora, are largely autonomous institutions, coordinated jointly by the Ministry of Health and theMinistry of Education and Science. Since the beginning of 1999, universityhospitals have been financed and administered by the Ministry of Health andthe teaching activities in these hospitals have been funded by the Ministry ofEducation and Science. The Medical University in Sofia has four faculties: medicine, dentistry,pharmacy and public health. Plovdiv has two faculties: medicine and dentistry.Varna has two faculties: medicine and public health. The other two schools inPleven and Stara Zagora have faculties of medicine only. Undergraduate medicaleducation for doctors lasts six years and includes five years of theoretical trainingand one year of practice, leading up to five state exams during the final year.The curriculum was recently reorganized to include 90 hours of teaching infamily medicine. After their residence and postgraduate qualification, doctorsregister their medical qualifications with the Ministry of Health and obtain alicence to practise their specialty in the Centre for Postgraduate Training atthe Medical University of Sofia. The SMC of Bulgaria has developed newcurricula for postgraduate specialization, undertaken in a hospital approvedby the Ministry of Health. There are 16 basic specialties for medicine in Bulgaria, each with an averageduration of three to four years (depending on the specialty and workplace of thetrainees). Each university is responsible for admissions and the organizationof specializations, but all trainees sit a final standardized examination in Sofiabefore they are allowed to practice their specialty. Doctors continue their training through postgraduate courses or continuingeducation and qualification according to the Regulation on Postgraduate Studies.Postgraduate courses are organized by the Ministry of Health and the Bulgarian Medical Association and training is conducted by the experts from research anddevelopment societies and medical universities. A system of credits is used toassess the medical specialists’ performance during studies. However, this systemstill requires more work and improvement of the assessment criteria.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Public health education and training in Bulgaria is closely related with university education of physicians. Until the beginning of the 20th century, Bulgarian physicians received their medical education and public health training abroad. The first Medical Faculty in Bulgaria was established in 1918 at Sofia University. The faculty included within its structure a Department of Hygiene. After 1945, four medical institutes were created in other cities in Bulgaria: Plovdiv (1945), Varna (1961), Pleven (1974), and Stara Zagora (1982), all of which were later transformed into medical universities whose educational curricula correspond to a great extent to the state medical education requirements. The first autonomous Department of Healthcare Organization was created in 1949 in the Medical Faculty in Sofia, and after that in other medical institutes. In 1964, the departments were renamed as Departments of Social Hygiene, and in 1984, they acquired the title Departments of Social Medicine. These semantic changes reflected the transformations within the curricula with regards to subjects taught.6 In the period between 1972 and 1981, the curriculum of subjects taught at the Departments of Social Medicine was broadened by including medical sociology and history of medicine. As of 1982, computer technology training in health care was added to the programme. During the 1990s, the undergraduate medical education included the subjects of social medicine, epidemiology, biostatistics, and history of medicine. Other departments which included public health education were Departments of Infectious Diseases and Epidemiology and Departments of Hygiene and Environmental Health. Postgraduate education was offered only to physicians in the following specialities: Social medicine, Epidemiology of Infectious Diseases, and Hygiene.

The Public Health Faculty trains specialists in the following fields: health care (BSc); health management, (MSc); economics of health care, health care marketing, medical ethics, medical pedagogy,epidemiological methods, patient rights (post-graduate courses).

The Faculty of Public Health prepares specialists with higher education in Health Management, Public Health, Health Care and Nursing and Midwifery. The Faculty comprises seven departments with 89 lecturers, 25 of whom having academic ranks. Doctor's Degree training may be carried out in 13 accredited courses. Postgraduate education is organized in the form of continuing education courses as well as individual courses for postgraduate studies. The Faculty of Public Health is a member of the Association of Schools of Public Health in the European Region (ASPHER) and Public Health in South Eastern Europe (PH-SEE), a founding member and a member of the National Network for Global Health.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Based on contracts with a number of foreign universities, the Faculty of Public Health carries out an active international exchange of students in the form of internships and practices and different in duration periods of training. FPH has the highest rating registered in the rating system of the Bulgarian higher education in the relevant field. Work in small groups allows the lecturers to pay individual attention to each student. Learners are provided with opportunities to participate in research projects in Europe and worldwide. The Faculty takes extra care of career development and the future of its students. 4.4 Croatia

Education in Croatia is a right defend by the Constitution which states that everyone has to have access to free compulsory education under equal conditions and in accordance with their aptitudes. Education is mandatory for children aged 6 to 15.

Educational system in Croatia begins with preschools-kindergartens. Children start their compulsory eight year long primary education from the age of 6. After finishing elementary school, students can continue their education, based on grades in elementary school, in four year non-compulsory secondary schools that are divided by the curriculum into gymnasiums, vocational (technical, industrial, trade) and art (music, dance, art) schools. Since 2010, the success on the Matura high-school exit exam is the basis of enrollment in higher education institutions. Higher education is conducted at institutions of higher education through university and professional studies. Higher education institutions are divided into polytechnics, colleges, faculties and academies of art. Since 2005, all study programs are aligned with the requirements of the Bologna Process. University study that lasts five years enables students to work in science, education, business, public sector etc., and can be at undergraduate (BA), graduate (MA) and postgraduate (PhD) level. Professional studies last two to three years, and are carried out at polytechnics and colleges, and provide students with the knowledge and skills that allow them to perform certain professional activities. By its completion, students get the title of professional bachelor. Attending public primary and secondary schools, as well as institutions of higher education, is free. Students only pay directly for textbooks, basic equipment, cafeteria food, student dorms and other necessities, although state also gives thousands of scholarships each year. In addition, the state pays health insurance for students. There are very few private schools in the country.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Education in Croatia has a long history, with the first university being University of Zadar, founded in 1396. Largest and the oldest continuously operating Croatian university is University of Zagreb, founded in 1669. Today, there are 940 primary and 390 secondary schools, as well as 90 public and 32 private higher education institutions in Croatia.

Students can enroll into two basic kinds of higher education:

 polytechnic schools (veleučilište), higher level education

 universities (sveučilište), highest level education The distinction between the programs taught at universities and polytechnics used to be the length of studies and the final classification of the students - but this line is being blurred by the implementation of the Bologna process. Previously, the veleučilište approximately matched the German concept of Fachhochschule. The 2003 changes to higher education legislation, which introduced the Bologna process in Croatia.

Since the Bologna process, the levels of expertise are: Bachelor of Science and Bachelor of Arts (prvostupnik)

Master of Science and Master of Arts (magistar)

Master of Education (magistar edukacije) Doctor of Science and Doctor of Arts (doktor)

The description of the Croatian higher education system as of July 2008 is available from the official Croatian Guidelines for the Publication of Diploma Supplement, which was published by the Ministry of Science, Education and Sports of the Republic of Croatia in July 2008. Although the document itself is in Croatian, the English description of the higher education system is available from page 25. The Croatian Institute of Public Health (CIPH) is the central public health institute of the Republic of Croatia. Founded in 1893 with the aim of promoting health and welfare of the population, CIPH now has a staff of 233 employees. The Institute focuses on public health promotion and education, disease prevention, microbiology, environmental health, school medicine, mental health care, and addiction prevention. Among its primary activities are

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

planning, promoting, and implementing measures for the enhancement of population health and reduction of health problems, as well as developing and implementing prevention programs, including immunizations. CIPH also carries out epidemiological surveillance and proposes, organizes, and undertakes preventive and counterepidemic measures. Additionally, CIPH performs conducts analysis and evaluation of water safety and the impact of environmental factors on human health in Croatia. The Institute functions as a statistical authority which maintains national public health registries, supervises data storage, and coordinates the work of other health registries. In addition to its commitment national public health, CIPH also coordinates the network of regional public health institutes, actively participates in the creation of health policy and public health regulations, and engages in international co-operation for the proposes of improving public health and welfare. Andrija Štampar The School of Public Health was founded in 1927 and today is a scientific and educational branch of the ZSM which organizes, implements, and promotes the teaching of undergraduate and graduate university studies of medicine and nursing and postgraduate studies. The school conducts re‐search and professional work, and various forms of professional and scientific training of employees in science, health and other institutions, primarily in the field of public health. The school scientifically and professionally supports the planning, development and evaluation of public health programs and policies in the governmental and non‐governmental sector. International cooperation isdeeply embedded in the Andrija Štampar School of Public Health since its founding. For years, the school has organized international programs of planning and management in health care in developing countries, and now runs international programs of education and research in their area of work. After the death of its founder dr. Andrija Štampar, the school took over his name. Štampar is one of the founders of the World Health Organization and an internationally recognized leader in the field of social medicine and public health. His principles, written back in 1926, are still valid and accepted in the international community.

The Department for Educational Technology was founded in 1986 on the experiences of a collaborative project of the Republic of Croatia and the Japan International Cooperation Agency (JICA) under the title “Continuous training for primary health care with the help of computer and video technology”. The Department is a specialized unit within the ZSM with the aim of developing, improving and constant monitoring of teaching technologies in the field of health and medicine. The teaching technology does not mean only the technique but also how to use the techniques, i.e. it is about educational technology that is based on the

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

innovative approaches in education up to the evaluation of the application of new educational strategies and methods. The tasks of the Department are: (a) monitoring the development of educational technology in the world and in our country, and the transfer of technology and evaluation, (b) the implementation of continuing education and support teaching, (c) technical support of the teaching process, especially the creation of audio‐visual teaching materials, (d) the dissemination of scientific information and health education and (e) scientific research (basic, developmental and applied) in the field of education, medical decision‐making, expert systems, and educational psychology. The Departmenthas encouraged the establishment of the Croatian Society for Medical Education, with whose aid the teacher‐training course “The Art of Medical Education” has been continuously running, as well as shorter teacher‐training which have been running since 2000. 4.5 Cyprus

4.5.1 Educational System

The right to education: Article 20 of the Constitution states that every person has the right to receive and every person or institution has the right to give instruction or education, provided that it will be in accordance with the Republic’s laws. Compulsory education: Compulsory education lasts for ten years and extends from the age of 4 years and 8 months (pre-primary education) to the age of 15 years (end of lower secondary education). Free education:

 Public education is free for all students in the age range of 4 years and 8 months to 18 years.

 Textbooks are also given to both students and teachers free of charge.

 Public tertiary (non-university level) education is also free.

 Public higher education (undergraduate level) is basically free for Cypriots and EU citizens, as the Government fully pays the fees which the Councils of the universities set. International undergraduate students from out with the EU countries pay fees.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Postgraduate students, Cypriot or international, pay fees set by the Council of Ministers.

 Adult education offered in public institutions is to a large extent free. However, a large number of training courses, mostly offered by private or semi government organisations, involve fees.

Governance: National legislation sets the aims and principles of education, the regulations of operation of schools or other educational institutions, examinations, funding and staff related issues.

Stages of the Education System: Early childhood education and careis organised on

 The pre-school system o Involves day nurseries (vrefopaidokomikoi stathmoi), where care and supervision is offered to children under the age of three.

 The pre-primary system o Involves kindergartens (Nipiagogeio). It concerns children in the age range of 3 years to 5 years and eight months.

Primary education is provided in primary schools (Dimotiko scholeio) and it comprises a six-year course of general education beginning at the age of 5 years and 8 months. Lower secondary education is provided in the lower secondary education schools (Gymnasio) and it comprises a three- year course of general education beginning at the age of 11 years and 8 months.

Upper secondary educationinvolves a three-year cycle which begins at the age of 15 years and is offered in two different types of programmes:

 The upper secondary general education programmes o Are called lyceums (Lykeia) and their programmes include both common core subjects and optional subjects of specialisation.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 The upper secondary technical and vocational education programmes o Is offered in the technical schools (Technikes scholes). These programmes include formal technical and vocational education offered in two streams - the theoretical stream and the practical stream. The apprenticeship scheme, which involves combined school and workplace courses, is also included in the programmes of the technical schools. Post- secondary non tertiary educationis offered to graduates of secondary education (18+ years old), at the Post- Secondary Institutes of Vocational Education and Training (Metalykeiaka instituta epaggelmatikis ekpaidefsis kai katartisis - MIEEK). The MIEEK offer two- year duration programmes of further vocational education and training.

Higher education is offered in public and private institutions, both at the university level (Panepistimia) and the non-university level (Scholes tritovathmias ekpaidefsis). In the academic year 2012/13, there are three state and five private universities in operation, while at the non-university level there are five public and twenty-five private institutions in operation.

Public universities include

 the University of Cyprus;

 the Open University of Cyprus;

 and, the Cyprus University of Technology. Public universities offer programmes at Bachelor, Master and Doctoral level. The Open University offers short courses in the lifelong learning sector as well. Private universities include

 the Frederick University;

 the European University-Cyprus,

 the University of Nicosia-Cyprus;

 the Neapolis University;

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 and the University of Central Lancashire, Cyprus (UCLan Cyprus), a British university operating in Cyprus. Private universities offer programmes at Bachelor, Master and, from 2010, PhD level.

Non-university level public institutions include

 the Forestry College;

 the Mediterranean Institute of Management;

 the Higher Hotel Institute of Cyprus;

 the Tourist Guides School;

 and the Police Academy. The general aim of each institution is to train professionals in its respective field, in order to satisfy the needs of local industry in Cyprus.

Private institutions offer vocational and academic programmes at various levels of study, such as the Certificate level (one-year duration), the Diploma level (two-year duration), the Higher Diploma level (three-year duration), the Bachelor level (four-year duration) and the Master level (one-year or two-year duration). The higher education system in Cyprus is shaped by the European Higher Education Area as outlined by the Bologna Process. In line with the Bologna main objectives, the European Credit Transfer System (ECTS) and the Diploma Supplement are used by all public universities and most of other institutions. Two independent bodies are responsible for quality assurance – the Council for Educational Evaluation and Accreditation (SEKAP), which is responsible for the evaluation and accreditation of programmes of study of non- university level private institutions in Cyprus, and the Cyprus Council for the Recognition of Higher Education Qualifications (KYSATS), which is responsible for the recognition of qualifications awarded by institutions of higher education in Cyprus and abroad. Adult education is offered in the form of formal education, non-formal education and vocational training, either in public institutions, or by semi-government or private organisations.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 The objective of formal adult education and training is to give working people the opportunity to gain a qualification that will improve their career prospects and enable them to reach their full potential.

 Non-formal continuing education aims at improving the quality of life of the individuals involved by offering them opportunities for self-development.

 Vocational training aims at upgrading the skills of individuals working in technical fields, and train unskilled or semi-skilled workers in vocational trades. Generally, there is not a comprehensive legislative framework for Adult Education and Training. Instead, there are a number of legislative provisions related to the different authorities involved. Special education is provided in mainstream schooling for the vast majority of pupils with special needs. In case full-time attendance in a mainstream class is not appropriate for the child's needs, special tuition in a resource room for specified periods per week may be recommended or, alternatively, attendance at a special unit within a mainstream school. If neither is considered suitable, the child is recommended to attend a public special education school. Second chance education is offered in evening schools, called evening gymnasia (Esperina gymnasia) and evening technical schools (Esperines technikes scholes), which offer four- year duration programmes to early school leavers (15 - 19 years old).

4.5.2 Public Health Education and Educational Institutions

Studies in the field of Public Health in Cyprus: Master:

 Master of Public Health o At theEuropean University Cyprus o Programme duration: 18 months (full time)

 Masters Degree In Public Health o At the University of Europe Laureate Digital: European University Cyprus o Programme duration: 18 months (full time or part time)

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Master in Public Health o At the European University Cyprus Online o Programme duration: 18 months (full time or part time)

 Occupational Safety and Health, M.Sc.

o At the European University Cyprus (EUC) o Programme duration: 18 months

 Environmental Health, M.Sc. o At Cyprus University of Technology o Programme duration: 1 year and 4 months

 Epidemiology and Biostatistics, M.Sc.

o At Cyprus University of Technology o Programme duration: 1 year and 4 months

 MSc in Health Education and Health Promotion o At Frederick University o Full time or part time

 MSc in Community Health Care (which offers two specialization options: A. General Family Health Care or B. Wound Prevention and Care)

o At Frederick University o Full time or part time

 Postgraduate Diploma (PgDip) and Master (MSc) in Family Medicine

o At the University of Nicosia o Programme duration: 18 months

 Master of Science in Contemporary Nursing (Contemporary Nursing Concentrations: 1. General Nursing, 2. Oncological Care, 3. Community Nursing)

o At the University of Nicosia o Programme duration: 1 year and 6 months (full time or part time)

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Master in Public Administration (MPA) (specializations: General Administration, Public Educational Administration, Management of Public Health Care) o At the Neapolis University Pafos o Programme duration: 1 year/ distance learning

 Master of Public Administration (MPA) (specializations: General Management, Management of Public Health Care, Public Educational Administration)

o At the Neapolis University Pafos o Programme duration: 1 year PhD:

 PhD in Environmental and Public Health o At Cyprus University of Technology

 PhD in Public Health

o At the European University Cyprus

4.5.3 Expenditure and Economics in Public Health

According to WHO estimates (WHOSIS and WHO HFA Database), Cyprus’s health care expenditure as a share of GDP is one of the lowest among EU countries and well below the EU average. From 1995 to 2008, THE grew on average at a faster rate than GDP, rising from 4.7% of GDP in 1995 to 6.0% in 2010.Cyprus’ total health expenditure as a percentage of GDP and government health spending as a percentage of total government expenditure are both quite low. Per capita spending in 2010 was $1842 US PPP, which is below the EU average.

In 2014, public health expenditure, total (% of GDP) of Cyprus was reported at 3,33 %. The public system has a large network of providers throughout the country. This network operates alongside that of the private sector, which offers primarily ambulatory care and to some extent hospital care, although data and documentation regarding the private sector is sparse. Nowadays, Cyprus devotes a relatively small share of resources to health care that reveals that the health sector is a low priority for the government.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

The private share of THE has consistently been high in comparison with other EU countries. This may appear somewhat surprising as Cyprus claims to provide care free of charge at the point of service for approximately 83% of the population. Private expenditures primarily consist of direct payments for private sector health care services, statutory co-payments and premiums for private health insurance schemes. In 2010, 83.5% of private expenditures were OOP payments and 9.4% were payments by private insurance Schemes. Aggregate data show that total health expenditure in Cyprus has an upward trend over time, with the private sector component exhibiting a slightly faster rate of increase than its public sector counterpart. The share of the private sector expenditure to total health care spending is slightly larger than the share of the public sector. More than half of aggregate expenditure on health services in Cyprus goes to the private sector, a fact also observed in the United States, but does not apply to other European countries.

Among the factors which are found to affect the level of household expenditure on health care are head’s education, household size, age mix, the presence of sickness benefit recipients or chronically ill/disabled persons in the household, as well as the age of the head and household income. For households with heads up to 40 years of age health expenditure decreases and then increases with the age of head. Health expenditure increases with income, albeit at a decreasing rate. In 2014, the share of long-term care services (including both the health and social components of long-term care) in current healthcare expenditure varied considerably among the EU Member States. In six EU Member States — Cyprus, Croatia, Romania, Greece, Slovakia and Bulgaria — long-term care accounted for less than 3.0 % of current healthcare expenditure.

4.5.4 Challenges and Future Perspectives

The importance of public health and specifically prevention and health promotion has long been recognized by the Ministry of Health as a cost-effective way to improve population health. The Department of Medical and Public Health Services within the Ministry of Health is responsible for organizing and delivering a wide spectrum of preventive and health promotion activities, including:

 epidemiological monitoring

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 control of sexually transmitted diseases

 services for expectant parents, pregnant women and children

 school health services

 immunization services

 control of environmental and communicable diseases

 occupational health

 health education and promotion. To accomplish these objectives various programmes have been implemented by the medical and public health services, the health visitors and the mother and child health centres in cooperation with local authorities, voluntary and non-profit organizations, as well as other ministries such as Agriculture, Natural Resources and Environment, Labour and Social Insurance, and Education and Culture.

Public health as a profession is becoming more and more popular because the professionals prevent disease and injury. Public health researchers, practitioners and educators work with communities and populations. They identify the causes of disease and disability, and they implement largescale solutions. For example, instead of treating a gunshot wound, they work to identify the causes of gun violence and develop interventions. Instead of treating premature or low birth-weight babies, they investigate the factors at work and they develop programs to keep babies healthy. And instead of prescribing medication for high blood pressure, they examine the links among obesity, diabetes and heart disease—and they use their data to influence policy aimed at reducing all three conditions.

Moreover, in public health, the microbiologists work to find a vaccine for malaria, while the behavioral scientists research ways to discourage populations from smoking. Εnvironmental health scientists work to discover which foods prevent cancer, while the health policy analysts evaluate health insurance programs and make recommendations. And the epidemiologists identify trends in health and illness, looking for links, causes and interventions in areas such as HIV/AIDS, tuberculosis and infant mortality.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Generally, public health is defined as the science of protecting the safety and improving the health of communities through education, policy making and research for disease and injury prevention. It encompasses areas as wideranging as chronic disease, the science of aging, mental health, disaster response, refugee health, injury prevention and tobacco control etc.

Today, the education in public health will be trained you to perform one or more of these ten essential services:

 Monitor the health status of a community to identify potential problems

 Diagnose and investigate health problems and hazards in the community

 Inform, educate, and empower people about health issues, particularly the underserved and those at risk

 Mobilize community partnerships to identify and solve health problems

 Develop policies and plans that support individual and community health efforts

 Enforce laws and regulations that protect health and ensure safety

 Link people to needed personal health services and ensure the provision of health care when otherwise unavailable

 Ensure a competent public health and personal health care workforce

 Evaluate effectiveness, accessibility, and quality of personal and population-based health services

 Research new insights and innovative solutions to health problems

Also, with a degree in public health, somebody could work for:

 Government agencies, such as the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), Occupational Safety and Health Administration (OSHA), Food and Drug Administration (FDA) or the Environmental Protection Agency (EPA), to name just a few.

 State and local health departments or agencies.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Nonprofits.

 Health care organizations, such as hospital systems and long-term care facilities.

 Private sector companies, such as health insurers and pharmaceutical companies.

 Colleges and universities, such as schools of public health or medicine. 4.6 Czech Republic

4.6.1 Educational System

Most of the population follows the compulsory schooling together at nine-year basic schools. Pupils usually transfer to upper secondary schools after the ninth year. They can choose from many general and vocational fields of different levels. The tertiary level of education offers a wide range of academically or professionally oriented studies mainly at higher education institutions, but also at tertiary professional schools.

Secondary education attainment in the Czech Republic is higher than the OECD average, whereas tertiary education attainment is lower. Ninety-four percent of 25-34 year-olds have attained at least secondary education (compared to the OECD average of 82%), and 25% have attained tertiary education (compared to the OECD average of 39%). The Ministry of Education, Youth and Sports is responsible for the state administration in education and for the state, conception and development of the education system. The Ministry allocates financial resources from the state budget, sets out the qualification requirements and working conditions of teachers, determines the general content of pre- primary to secondary education and approves educational/study programmes of schools at the tertiary level.

In the Czech Republic there are 26 public, 2 state and 40 private higher education institutions.

Public spending on education, total (% of GDP) in Czech Republic was reported at 4.3 % in 2011.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.6.2 Public Health Education and Educational Institutions

The main actors in the Czech system of public health were the National Institute of Public Health (SZÚ), the two regional institutes of public health and the 14 regional public health authorities. All of these institutions are directly subordinate to, and managed by, the Ministry of Health and its chief public health officer, who is also a deputy minister of health. The National Institute of Public Health (NIPH) is a health care establishment for basic preventive disciplines - hygiene, epidemiology, microbiology and occupational medicine. Its main tasks are health promotion and protection, disease prevention and follow-up of environmental impact on the health status of the population. The National Institute of Public Health plays an active role in pre- and postgraduate training of physicians and other health care workers and provides consultations to professionals working in the field. The Institute for Postgraduate Medical Education /IPVZ/ was established in 1954 by Ministry of Health of Czech Republic. Since its inception has demonstrated the ability to perform tasks in the area of specialization and continuing training of health professionals, which helps to increase the quality of education of doctors and improves the quality of health care in the Czech Republic. Currently, the Institute has 94 of educational centers (36 departments, 50 subdivisions, the School of Public Health and learning workplaces and departments). There do not exist any dedicated bachelor or master programmes in public health in the Czech Republic. Programmes that partly include public health topics are, among others, the Master in Health and Social Care Management offered by the Sevanan Business School and the one-year Master in Healthcare Administration offered by the Central Bohemia University. Public health issues are also covered by all Czech medical faculties in masters programs under the topics as hygiene, epidemiology, preventive medicine, medical law, healthcare organization, health informatics and statistics, that are assigned to different departments of medical faculties. Only in the postgraduate training organized by the Institute for Postgraduate Medical Education is the course covering all topics together under the name Public Health.

4.6.3 Expenditure and Economics in Public Health

Health expenditure, public (% of GDP) in Czech Republic was reported at 6.3 % in 2014. Public health expenditure consists of recurrent and capital spending from government (central and local) budgets, external borrowings and grants (including donations from

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

international agencies and nongovernmental organizations), and social (or compulsory) health insurance funds.

4.6.4 Challenges and Future Perspectives

A long-term public health strategy, the National Health Programme, was submitted for government approval and accepted as early as 1995. The chief goal of the programme is to encourage individuals to take an active approach to their health; it includes projects for healthy schools, homes, workplaces and cities. The National Health Board, led by the Minister of Health, is responsible for implementing the programme and reviewing applications for funding submitted by public and private organizations. A new strategic document was adopted in 2012 to better reflect the institutional changes which have happened since 1995 and also to reflect the WHO Health 2020 Strategy. The new document emphasizes the promotion of healthy lifestyles and raising awareness about the available preventive services such as screenings. A recent analysis by Bencko (2013) stresses the necessity to educate healthcare professionals and the general public in the fundamental principles and importance of primary prevention in context with medical practice. This covers timely notification of infections, their flexible surveillance, reports on malignity to the national cancer register and, primarily, the necessity of personal engagement in primary prevention programmes. He writes that a certain hope open in the future is that the steadily rising cost of medical treatment will urge responsible political bodies to recognise the importance of primary prevention from both cost/benefit and evidence-based aspects, leading to the introduction of associated principles in national healthcare policy. He summarizes that the problems and tasks of the future require unrestrained cooperation of public health and epidemiological branches. The future focus of interest in the Czech public health service remains on the development of novel strategies for analysis of health risks in the prevention of disease: this will be the major public health priority in the 21st century. 4.7 Denmark

4.7.1 The Educational System, Structure and Management, Students Demographics, Legislation

Primary and lower secondary education:

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

The Danish public school – the ‘Folkeskole’ - is a comprehensive, integrated municipal school covering primary and lower secondary education (ISCED 1 and 2) without streaming. In the 2014/2015 school year, 78 % of all pupils in primary and lower secondary schools attended the public school, 16 % attended private schools, 4 % attended private residential schools known as ‘Efterskoler’, and 2 % attended special schools. Education is compulsory for ten years starting from the year the child turns six.Apart from the compulsory grades 0 to 9, the public school also has an optional grade 10. In the 2014/2015 school year, 51 % of pupils having attended grade 9 also attended grade 10. The average number of pupils per class in the public school is 21.4, while the figure for private schools is 18.1 (2014/2015). General and vocational upper secondary education:

In Denmark, upper secondary education programmes, also referred to as youth education programmes, can be divided into: – General upper secondary education programmes, which primarily prepare students for higher education. – Vocational upper secondary education and training programmes, which primarily prepare students for a career in a specific trade or industry. General upper secondary education programmes: There are four academically oriented general upper secondary programmes: – The 3-year Upper Secondary School Leaving Examination, Gymnasium (stx) – The 3-year Higher Commercial Examination (hhx) – The 3-year Higher Technical Examination (htx) – The 2-year Higher Preparatory Examination (hf) All four programmes prepare students for further studies while also developing the students’ personal and general competencies. The programmes aim to enhance the students’ independent and analytical skills as well as preparing them to become democratic and socially conscious citizens with a global outlook.

Vocational education and training (VET): VET includes more than 100 main programmes leading to almost 300 different qualifications at level 3 to 5 in the Danish qualification framework. The duration varies from 2 to 5½ years, the most typical being 3½ to 4 years. VET programmes are combination ”sandwich-type” programmes in which theoretical and practical education at a vocational college (approxmately 1/3 of the time) alternates with practical training in an approved company or organisation (approximately 2/3 of the time). The dual training principle building on apprenticeship contracts in companies ensures that the

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

trainees acquire theoretical, practical, general and personal skills which are in demand in the labour market. Higher education: Danish higher education institutions use the European Credit Transfer System (ECTS) for measuring study activities. 60 ECTS correspond to one year of full-time study. Higher education programmes are offered at five different types of institutions, each with well- defined profiles and qualities. Academy profession programmes:Academy profession programmes offer professionally-oriented short-cycle and first-cycle degree programmes of 90-150 ECTS in fields such as business, technology and IT. Holders of an academy profession degree can obtain a professional bachelor’s degree within the same field of study through a top-up programme of 90 ECTS. Professional bachelor´s programmes:Professionally-oriented first-cycle degree programmes of typically 180-240 ECTS are offered in fields such as business, education, nursing, engineering and maritime transport. The programmes have a strong focus on professional practice and provide students with theoretical knowledge and its application to professions and industries. The programmes include a period of work placement of at least 30 ECTS. Most programmes provide access to further studies in the same field. University colleges and specialised colleges offer the professional bachelor´s programmes. University level programmes:There are three levels of study programmes offering first-, second- and third-cycle degree programmes in academic disciplines: Bachelor’s programmes: The bachelor’s degree (BSc/BA) is awarded after 180 ECTS and qualifies students for a professional career and further studies at second-cycle level.

Master´s programme (candidatus): Most students choose to continue on a master’s programme (MSc/MA) of 120 ECTS. They usually include one or two of the major fields of study of the bachelor programme. Independent research activities and a master’s thesis of at least 30 ECTS are required. The master’s programmes qualify students for a professional career and for scientific work.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

PhD: The PhD degree is obtained after 180 ECTS and consists of research, participation in research courses, teaching and public defense of a thesis. The programmes are offered at the Danish universities, which are research-intensive institutions offering research-based study programmes. 4.7.2 Public Health Educational Institutions

National network of Graduate programmes in public health (GRASPH): comprising Aalborg University, Aarhus University, University of Southern Denmark and University of Copenhagen. The main purpose of the network is to organize a summer school. The National Institute of Public Health (NIPH): is Denmark's national public health institute. The NIPH is a research institute under the Faculty of Health Sciences, University of Southern Denmark. Before January 2007 the institute belonged under the Danish Ministry of the Interior and Health. The NIPH is based in Copenhagen. The Department of Public Health: departments of Public Health are integrated in the Universities of Copenhagen, Aarhus and Southern Denmark. They facilitate teaching in every degree programme within the Faculty of Health Sciences.For example in the University of Copenhagen, it is responsible for the BSc/MSc in Public Health, the MSc in Global Health and the professional master's programmes in Public Health (MPH) and Disaster Management (MDMa), which together total 600 students. School of Global Health:The overall purpose of School of Global Health - University of Copenhagen is to coordinate and improve health research and training at the University of Copenhagen, in collaboration with local and global partners, and to promote health and development by research- and evidence based interventions against major health problems affecting low- and middle income societies.

4.7.3 University Programs in Public Health both Undergraduate and Postgraduate

The Graduate programme in Public Health and Epidemiology (PHE): covers a comprehensive area consisting of population-based epidemiology, clinical epidemiology, social medicine, environmental medicine, industrial medicine, research in prevention and health promotion, and health services research. PHE is anchored in the Department of Public Health at University of Copenhagen.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Short Courses: Denmark offers various short courses in the field of Public Health. These are primarily designed for public health students.

 The University of Southern Denmark (SDU) offers the following educational programmes:

Public Health:

o Master's Degree Programme in Public Health

Global Health:

o Master's Degree Programme in Global Health

 In the Aarhus University the Department of Public Health contributes to the following Degree Programmes:

Public Health:

o Bachelor's Degree Programme in Public Health Science

o Master's Degree Programme in Public Health Science Sport Science:

o Bachelor's Degree Programme in Sport Science

o Master's Degree Programme in Sport Science

Medicine:

o Bachelor's Degree Programme in Medicine (Medical Science)

o Master's Degree Programme in Medicine (Medical Science)

Health Science:

o Master's Degree Programme in Health Science

Nursing:

o Master's Degree Programme in Clinical Nursing

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o Master's Degree Programme in Nursing

 In the University of Copenhagen the Department of Public Health provides teaching and supervision for all programmes at the Faculty of Health Sciences. The following educational programmes are based at the Department of Public Health:

o BSc in Public Health Science

o MSc in Public Health Science

o MSc in Global Health

o Master of Public Health (MPH)

o Master of Disaster Management (MDMa)

o Graduate Programme in Public Health and Epidemiology

4.7.4 Continuing Education, Life Long Learning

The strategy for lifelong learning in Denmark includes the following objectives:

 A coherent education system from pre-school to higher education must provide the opportunity for everyone to acquire excellent basic skills, a qualifying education and a solid foundation for lifelong learning. There must be equal opportunities and room for all.

 The education programmes must be world-class. The education system is to foster talent and be more accommodating to weak learners. Quality is given pride of place, and education must match the needs of the labour market and the society.

 There must be relevant, high quality adult education and continuing training for everyone in the labour market which matches the needs and puts particular emphasis on the need for lifelong skills upgrading for those with the lowest level of education. There is a shared responsibility to ensure that everyone in the labour market is engaged in lifelong learning.

 Systematic competence development in the workplace should be strengthened in both public and private enterprises. Increased public and private investment in

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

continuing training and competence development for employees is to contribute to improving the skills of individuals and strengthening the development of the enterprises.

 Opportunities for guidance and counselling must be improved and help ensure the best possible conditions for pupils, students and adults to choose education programmes and to participate in lifelong learning.

 All forms of education and learning should be based on and build on the knowledge, skills and competences of individuals. In adult education and continuing training new and improved opportunities are to be created promoting visibility and recognition of an individual’s prior learning.

 Coherent education paths and transparency in the education system are to contribute to targeted education and lifelong skills upgrading and facilitate the best possible use of public resources.

 A global perspective must be included in all education programmes contributing to strengthening internationalisation and cooperation with the world around us.

 Stronger higher education environments are to be created in order to contribute to higher quality in education and knowledge development, and a better framework and better conditions are to be developed for interaction between educational institutions and enterprises and other relevant players. In order to fulfil the overall objectives of education and lifelong skills upgrading, the Government has prioritised a number of specific goals and initiatives within the overall education system and in the area of adult education and continuing training. Lifelong learning is also being supported and promoted through actions and initiatives in a large number of other areas, for example employment and integration efforts, liberal adult education and in association and cultural activities. Realisation of the extensive reforms is predicated on all relevant players accepting coresponsibility and making an active contribution. It is the aim of the Government to strengthen dialogue and partnerships between all players. This is decisive for realising Denmark’s strategy for education and lifelong skills upgrading. According to this strategy a variety of courses for continuing education and training are offered online and / or in public and private institutions all around Denmark.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.7.5 Public Health Professionals Certification (Legislation)

The main programs for public health professionals can be seen in 3. University programs in Public Health both undergraduate and postgraduate. In addition to these certified qualifications there exists also a Public Health Certificate Online Graduate Program.

Denmark Public Health Certificate Online Graduate Programs:Often designed with the mid- career professional in mind, Public Health Certificate Online Graduate Programs offer a convenient alternative to traditional campus settings.Many universities and colleges have distance learning options for students who live too far, have to balance a full-time job or family obligations with their coursework. Public Health comprises quite a few subfields from epidemiology and biostatistics to health services and health education. If you are not quite ready for a graduate degree but do want to update your present competencies and knowledge base, an online public health graduate certificate warrants some consideration. Online Public Health Certificate - Program Basics: Many accredited Public Health Graduate Schools have online graduate certificate programs which consist of anywhere from 9 to 21 credit units of advanced coursework in public health topics (e.g. biostatistics, epidemiology, environmental health, health policy and health administration, social and behavioral sciences). In some cases, the credits earned may be applied to a more advanced degree (such as the MPH or MSPH). In fact, some students might enroll in Public Health Graduate Certificate Online programs instead of a full graduate degree as they are shorter in duration, and offer take-away knowledge if you are currently working in the field. On the professional side, graduate certificate programs provide continuing education credit opportunities for many careers. Those seeking to refocus or boost their current careers without enrolling in an entirely new Public Health degree program may also benefit from graduate certificate programs.

Potential Features of Public Health Certificate Online Graduate Programs: Referred to in some descriptive texts as ‘convenient’ and ‘flexible’, Public Health Certificate Online Graduate Programs are certainly different from traditional campus programs in that there is no regular commute; you do have the leeway to schedule study when you have the time for it. However, not all programs are the same so as you explore some choices, make sure to see whether it truly matches your needs. Here are a few points to consider:

 A fully online graduate Certificate in Public Health program is typically one where you have access to your courses on a 24/7 basis. These courses are asynchronous,

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

meaning they are prerecorded. The potential advantage to this is that you can be anywhere you have Internet and log into your course management system. This same web portal is usually the way assignments are submitted.

 A partially online Public Health Graduate Certificate Program typically means that the majority of your courses are delivered via web with the exception of the courses that require live demonstration, in-person participation or meetings that you need to be present for. It may also mean that some of your lectures are live-streaming.

 Support systems for online programs may be the same as for the campus programs, although certainly, there should be a strong tech support in addition to student services

 Staying connected to classmates and professors may be via email, text, web chat or participation in group forums.

 Faculty may or may not be the same professors who teach the on-campus programs; this is definitely something to find out when you have narrowed down a few online universities.

 In terms of facilities, if you will have laboratory requirements, find out how to fulfill these in a distance-learning program. Types of Public Health Certificate Online Graduate Programs:There are any number of options for Public Health Certificate Online Graduate Programs from general areas in public health through to quite targeted areas such as:

 Bioethics Online Graduate Certificate Programs

 Epidemiology Online Graduate Certificate Programs

 Health Education & Communication Online Graduate Certificate Programs

 International Health Online Graduate Certificate Programs

 Occupational Health & Safety Online Graduate Certificate Programs Potential Curriculum: Curriculum for online Graduate Certificates in Public Health varies between universities and is dependent on ‘what’ you are studying. Some topics that students might learn could include:

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Basic Principles of Epidemiology

 Public Health Policy

 Environmental Health

 Workplace Health and Safety

 Biostatistics

 Behavioral Aspects of Public Health Accreditation: Accreditation is just as important for Public Health Certificate Online Graduate Programs as for campus ones. You can check this easily; in the U.S., The Council on Education for Public Health (CEPH) is the agency which accredits schools of public health and programs of public health. They are approved by the U.S. Department of Education.

4.7.6 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

The topic e-learning is omnipresent in the lectures and courses regarding Public Health in Denmark. They often include:

 Online self-assessment of e-learning modules.

 Weekly assignments combining lectures, quizzes, exercises and on-line discussions.

 Study of uploaded literature.

4.7.7 Expenditure and Economics

Denmark’s governmental expenditure for education was (in 2011) 13.5 %. It’s public health expenditure as share of the GDP is the second highest in the OECD (after Iceland). The highest public spending on education relative to GDP was observed in Denmark (8.8 % of GDP, 2011 data). This reflects large subsidies to the educational system, which make the system virtually free of charge for its users. Public spending on education is as well supplemented by private expenditure. The expenditure of educational institutions was in

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

2012 around 11.315 (million EUR). Public expenditure on education (excluding early childhood educational development) as a share of GDP in 2012 was approximately 8.8 %. 4.8 Estonia

4.8.1 The Educational System, Structure and Management, Students Demographics, Legislation

The current Estonian educational system consists of pre-school education, basic education, general secondary education, vocational education and higher education. Basic education is the compulsory educational minimum which is provided by basic schools (grades 1-9). Children reaching the age of seven have to attend school.On completion of basic education, studies may be continued in an upper-secondary general school (grades 10-12) or in a vocational institution.Vocational education is offered by upper-secondary vocational school and post-secondary professional school. Post- secondary professional school gives a vocational higher education.Higher education is divided into two parallel sectors, applied higher education (diploma studies) and the academic higher education (bachelor’s, master's and doctorate studies). Estonia has the following types of higher educational institutions:

 public universities;

 private universities;

 public institutions of applied higher education;

 private institutions of applied higher education. There are six public universities in Estonia. The universities are autonomous to the extent determined by the law of universities. This autonomy means that universities have the right to independently determine their academic and organisational structure, content of teaching and research work, course curricula, requirements for admission and graduation, etc.

Higher education in Estonia is both academically and practically oriented. Teaching is carried out in various forms such as lectures, seminars, group work, laboratory work and independent studies. In the process of learning, the students' responsibility and individual

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

performance are considered important and the grades obtained reflect not only the results of the final examination but also the participation in the course.

Science degrees may also include laboratory and practical work requirements. A significant feature in all teaching and studying at the Tallinn University is the use of modern technology that is conveniently accessible to all staff and students.

4.8.2 Public Health Educational Institutions

The only public health study programme at Estonian Higher Education institutions is a Master’s programme in Public Health at the University of Tartu. Institutions involved in public health activities are the Ministry of Education and Research, the Office of the Minister for Population and Ethnic Affairs and the Ministry of Culture. Institutional structure: Following a period of reform of the institutional structure of public health governance in Estonia, as the former sanepid system was reformed and Estonia prepared for EU membership, a variety of institutions is responsible for public health. The stewardship and oversight of public health is governed primarily by the Ministry of Social Affairs. The Ministry conducts continuing strategic planning, which also takes place at the local level, and is responsible for appropriate acts, laws and regulations. The Ministry has three administrative divisions on labour, social and health policy. The health division is further divided into the Health Care, Public Health, Health Information and Analysis and e- Health departments:

 The Health Care Department formulates health care policy and organizes its implementation to ensure access to and quality and safety of health care services and pharmaceuticals, and ensure the population’s awareness of and satisfaction with health care services. The Department has a lead role in all health care and pharmaceutical policy developments in the health sector.

 The Public Health Department formulates health policy and organizes its implementation to ensure a healthy environment, promote health and prevent diseases and the damage they cause. The Department has a lead role in health policy development in the following areas: environmental health risks (e.g. drinking-water, bathing water, indoor air, noise, food and chemical safety); control of infectious diseases; immunization; prevention of noncommunicable diseases; child and

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

adolescent health; prevention and control of drug addiction and rehabilitation of addicts; and prevention and control of tobacco smoking and alcohol misuse.

 The e-Health Department manages and coordinates the e-health project, including planning and implementation, administration, the development of health information systems, the standardization and implementation of data sets, nomenclature and the classification of medical documents.

 The Health Information and Analysis Department creates the conditions for knowledge-based policymaking in the Ministry to ensure the objective assessment of the health system’s development and the impact of planned or implemented policies. For policy-making, the Department must coordinate the collection of health statistics, collect and introduce the best international practices and support the development and efficient implementation of intellectual capacity.

In addition, four agencies operate under the auspices of the health division: the State Agency of Medicines, the Health Care Board, the Health Protection Inspectorate, the Chemicals Notification Centre and the National Institute for Health Development.

4.8.3 University Programs in Public Health both Undergraduate and Postgraduate

The University of Tartu trains medical doctors, dentists and pharmacists; it is the only institution in Estonia offering academic education in medical sciences and nursing. Two public nursing colleges (Tallinn and Tartu health colleges) offer higher professional training to nurses and midwives. Since 1996, nursing and midwifery training have been harmonized with EU requirements. Public health specialists receive training at the University of Tartu’s Faculty of Medicine, which offers a Master’s programme for public health (Master of Science in Health Sciences) in the specialties of health management, health promotion, occupational health and environmental health. In addition, occupational therapists and specialists in health promotion and health protection can receive training at health colleges. 4.8.4 Continuing Education, Life Long Learning

The development of and investment in the public health workforce are essential for the delivery and implementation of public health functions and services. Human resources constitute the most important resource in delivering PHS. This function includes the

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

education, training, development and evaluation of the public health workforce, to identify the needs of PHS to address priority public health problems. Training does not stop at the university level. Continuous in-service training is needed – not only in development and new challenges in public health but also in economics, bioethics, management of human resources and leadership – in order to implement and improve the quality of PHS.

4.8.5 Public Health Professionals Certification (Legislation)

The procedures for licensing public health professionals establish the requirements of the future workforce for relevant public health training and experience. They should also include mechanisms for evaluation and continuous quality improvement. 4.8.6 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

Training medical students in using a multilingual, virtual, simulated patient: A project for use of multilingual, virtual, simulated patients in medical education across Europe is providing greater flexibility in learning. The initiative, which includes 11 countries in the Region, involves creation of a multilingual, virtual, simulated "patient" that responds and behaves in the same way as a real patient being seen in a primary care setting. It can be used by medical students in different countries with different languages. The system simulates a clinical interview with a virtual patient presenting with symptoms of one or a combination of illnesses. During the interview, it can express moods, which can be adapted to both the virtual simulated patient's illness and the student's behaviour. Such role-play scenarios not only help students to detect illnesses but also add to teaching of communication skills and reduce reliance on actors, the use of whom can be time- consuming and costly.

4.8.7 Expenditure and Economics

The training of medical doctors, dentists, pharmacists and nurses is financed mainly by the state, but students can also pay for training privately. The training of other public health specialists, such as occupational therapists and environmental health specialists, is financed mainly by individuals or institutions that need them.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.8.8 Challenges and Future Perspectives

The lack of training in some specialties is aggravated by a lack of national planning for them. There are insufficient data about the current number of specialists in many areas and therefore about the gap between coverage and requirements. This is also a question of strategic planning that ought to be addressed by the strategic planning process and the overall public health strategy. This lack of action combined with discontent about salaries of health personnel, the lack of a collective salary agreement and high workloads formed the main triggers for a national strike of physicians and nurses in October 2012. They also argued that the government had failed to proceed with vital structural reforms for many years, such as restructuring the provider network and addressing issues of sustainability of the health system.

Resources for training are inadequate for the public health needs identified, and these need to be further developed in general, as well as to include new specialties. There are distinct gaps in training at the bachelor’s and Master’s degree level: while curricula exist for the training of health care specialists, there are no such courses for epidemiologists, biostatisticians, toxicologists, etc. Doctors’ knowledge on dealing with patients with drug problems is ad hoc and self-taught. In addition, postgraduate training of specialists in environmental health and epidemiology is lacking; most licensed experts in environmental impact assessment have a professional background in environmental expertise, rather than health expertise. The problems with training underpin the most severe problems with human resources in public health and they pose a threat to the ability of the Government and other actors to improve PHS. Another problem, however, is specialists’ leaving public health for work elsewhere in the health system or beyond, in which a key factor is the relatively low remuneration in some areas.

The remuneration for some public health professionals and the incentives for people to enter the public health field are also a significant issue. It needs to be addressed within a strategic framework, as it affects people’s choices of training. For this reason, changes in remuneration have a long lead time in terms of their effect on the human resources market in public health. Problems remain in attracting people to public health professions, including both low salaries and low general recognition of public health positions. The number and training of specialists are generally insufficient. As a result, positions in some key areas are vacant. These vacancies are of two types: positions that are unattractive due to reputation and/or salary (e.g. HIV, drug abuse, which are not popular career choices)

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

and those due to a general shortage of trained experts, which is more related to problems with training capacity.

Recommendations:

 Develop a long-term strategic human resources plan, including training and retraining of specialists, with a focus on innovative incentives.

 Create a well-defined human resources function within the Public Health Department.

 Make a full assessment of what training needs are implied by the human resources plan.

 Analyse the capacity of primary health care practitioners to undertake public health activities for disease prevention and health promotion.

 Examine the funding of public health professions to ensure competitiveness.

 Develop training capacity in relevant areas, including some specialties. 4.9 Finland

4.9.1 Description of Educational System, Structure and Management, Students Demographics, Legislation

The Finlands’ educational system is consisting from Pre-Primary education (6 years old) and Basic education (7-16 years old). After their nine-year basic education in a comprehensive school, students at the age of 16 may choose to continue their secondary education in either an academic track (lukio) or a vocational track (ammattikoulu), both of which usually take three years and give a qualification to continue to tertiary education. Tertiary education is divided into university and polytechnic. The only national examination, the matriculation examination, is held at the end of general upper secondary education. Commonly admission to higher education is based on the results in the matriculation examination and entrance tests. Governance has been based on the principle of decentralisation since the early 1990s. Education providers are responsible for practical teaching arrangements as well as the

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

effectiveness and quality of the education provided. Local authorities also determine how much autonomy is passed on to schools. For example budget management, acquisitions and recruitment are often the responsibility of the schools. Polytechnics and universities enjoy extensive autonomy. The operations of both polytechnics and universities are built on the freedom of education and research. They organise their own administration, decide on student admission and design the contents of degree programmes.

The Finnish National Agency for Education follows the development of educational objectives, content and methods according to the performance agreement with the Ministry of Education and Culture. The activities of the Finnish National Agency for Education include implementing national education policies, preparing the national core curricula and requirements for qualifications, developing education and teaching staff as well as providing services for the education sector and administrative services. According to the data of Statistics Finland's education statistics, there were 1.27 million pupils and students in Finland in 2015. The number of students grew slightly in comprehensive school education, upper secondary general school education, vocational education and university of applied sciences education. The number of students in university education declined. In 2015, the number of new students totalled 283,100 and that of attainders of qualifications or degrees 223,500. A total of 52 per cent of new students and 54 per cent of attainders of qualifications or degrees were women. There were most foreign-language speaking students, whose native language was not Finnish, Swedish or Sami, in Southern Finland. Most commonly, the native language of foreign- language speaking students was Russian or Estonian. Foreign students' nationality was most often Russian, Estonian or Chinese.

4.9.2 Public Health Educational Institutions

Finland has five universities in medicine: University of Helsinki, University of Turku, University of Tampere, University of Eastern Finland, and University of Oulu. The Finnish specialized hospitals are situated in these cities. The Faculty of Medicine, University of Helsinki, offers the undergraduate degrees of Licentiate of Medicine, Licentiate of Dentistry, and Master of Science (graduates from the international Master’s Programme in Translational Medicine). The undergraduate degrees of the Faculty of Medicine will also include the degrees of Bachelor of Arts (Psychology) and Master of Arts (Psychology) as well as the degrees of Bachelor of Arts and Master of Arts with a major in logopedics.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

The Faculty of Health Sciences at University of Eastern Finland educates and train experts and professionals for several central fields of health care and well-being. We offer education in programmes of medicine, dentistry, pharmacy, biomedicine and health sciences (clinical nutrition, ergonomics, exercise medicine, nursing science and public health).

Faculty of Medicine, FoM, University of Oulu is an essential part of the Life Sciences Campus Kontinkangas and is situated next to the University Hospital of Oulu. The campus is a unique combination of partners in research, education, health services and business. Faculty is the most versatile educator in health sciences. In addition to MD and DDS degrees the students can accomplish Master´s level education in nursing science, health management science, teacher education in health science and in medical bioengineering. The Faculty of Medicine and Life Sciences, University of Tampere combines the studies and research in biotechnology and medicine. The Licentiates of Medicine and Masters of Science (in Biotechnology) graduating from the faculty get exceptionally good skills for conducting research in personalised medicine and its applications. The medical students also get excellent skills for practicing medicine in health care organisations. In addition, the faculty also organises scientific and postgraduate medical education. The Faculty of Medicine, University of Turku has a unique profile among the Finnish medical faculties, since it hosts several Master’s degree level programmes (Dentistry, Medicine, Nursing Science, Biomedicine and Biomedical Imaging). Faculty of Medicine offers also specialization training in 55 specialization programmes and doctoral training in 48 main subjects.

In Finland nurses receive their education at Universities of Applied Sciences (also called polytechnics). Public health nurses, midwives and paramedics are also qualify through the same schooling (AMK in Finnish). The degree includes the registered nurse’s qualification. They are completing the studies, consisting of 210 - 270 ECTS credits, lasts from 3.5 to 4.5 years. Registered nurses require 210 credits, public health nurses and paramedics 240, and midwives 270.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.9.3 University Program in Public Health – both Undergraduate and Postgraduate

All five universities organise study programmes in public healthcare, and in Finland exists 31 different bachelor programmes in public health, 13 master programs and 2 PhD study programmes.

The network for nurse education is wider, and does not exist clear data about programmes especially in public health.

4.9.4 Continuing Education, Lifelong Learning

Finland has a long history of participation and promotion of adult education. Adult education is also very popular and the participation rate is high in international terms. The main objectives of adult education policy are ensuring the availability and competence of the labour force, providing educational opportunities for the entire adult population and strengthening social cohesion and equity.

The medical institutions organise constant trainings for health professionals, as well for education of general audience about preventive medicine.

4.9.5 Public Health Professionals’ Certification (Legislation)

The practice of medicine in Finland is subject to a permit to practice the profession of physician or a licence to practice medicine issued by the National Authority of Medicolegal Affairs. Physicians granted such permit or licence are registered in the Central Register of Health Care Professionals (TERHIKKI) maintained by the National Authority for Medicolegal Affairs.

4.9.6 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

The Finnish educational system is recognized as one of the best in the EU, but the one that does not use much ICT in learning. Two master programmes in public health offer completely remote studies:

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Global Development and Management in Health Care at Laurea University of Applied Sciences

 Social and Health Care Development and Management (YAMK) at Lahti University of Applied Sciences

4.9.7 Expenditure and Economics

Finland expenditure for education amounts about 7,5% of GDP, and it is one of the highest level in EU. Most education and training is publically funded. There are no tuition fees at any level of education. An exception is the tuition fees for non-EU and non-EEA students in higher education, effective from autumn 2016.

4.9.8 Challenges and Future Perspectives

In recent years, a cut in the number of new student places has often been called for by the economic sphere, as well as trade and student unions, because of an ongoing trend of rising academic unemployment, which is interpreted as a result of the steep increase in student places in higher education. An increase in vocational school student places might be preferred, as a shortage of basic workforce such as plumbers and construction workers is widely acknowledged in Finland. It should also be noted that retiring age groups are bigger than the ones entering higher education in Finland at present and for quite some time into the foreseeable future. 4.10 France

4.10.1 Description of Educational System, Structure and Management, Students Demographics, Legislation

The Ministry for Education defines France’s national educational curriculum. The Ministry is organized on a regional basis, with 13 academic regions responsible for maintaining nationwide standards in education policy, along with 26 mainland academies and four academies in France’s overseas territories responsible for public service aspects of education (including defining strategy and managing schools and personnel).

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

In France, school is mandatory for all children aged 6 to 16. Children may also attend school from the age of three. At the beginning of the 2016-2017 school year, a number of schools opened classes for children aged two. There are three different types of school:

1. State schools, which are run by the government.

2. State-funded and controlled private schools. These establishments must adhere to the terms and conditions of their contract with the government. In exchange, the government pays their teaching staff. Local authorities fund these establishments to the same extent as state schools. 3. Privately funded schools, which are also subject to government inspections of both their management and teaching; all staff must possess the required qualifications. The teaching provided must comply with French education law and meet minimum standards of knowledge.

The stages in French educational system are divided on: kindergarten education (3-5 years), elementary school (6-10 years), Junior High School (11-14 years), Senior High School (15-18) and higher education (bachelor, master, PhD).

Compared to other countries, France has an unusual and complex system of higher education. While France has close to a hundred universities (82 state universities, plus 5 Catholic universities and a large number of private "institutes", some of which award degrees), most of them able to hold their own as regards teaching and research with universities in other parts of Europe, the peak of the education pinnacle in France is represented by the country's "Grandes Ecoles", relatively small and highly selective "schools" which provide a cosseted higher education to the nation's future elites - tomorrow's "haut fonctionnaires" (senior civil servants), leaders of industry, top military brass, top politicians, engineers, physicists and others. In spite of the national preoccupation with equality and equal opportunities, the top end of the French higher education systems is elitist. Grandes Ecoles are very well funded, have small classes and top teaching staff; indeed they (and the lycée classes preparing students for their competitive entry exams) siphon off a disproportionate amount of the education budget - to the detriment of France's universities that are considerably underfunded, compared with international standards.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Basic standard student fees in France for the 2016-2017 academic year are 184 € per year for undergraduates, and 256 € per year for post graduate Master's courses - plus a few extras that may add on less than 100 €. For administrative purposes, France is geographically divided into 31 educational regions known as académies. Each académie is headed by a recteur, a representative of the Ministry of Education, who is in charge of all education levels within that region. Each académie is further divided into départements, which are headed by an inspecteur d’académie, who oversees primary and secondary education. A law adopted in 1989 established that while the Ministry of Education is responsible for creating the curriculum and setting educational standards and goals, each primary and secondary school has the autonomy to choose how to best teach the curriculum and achieve state-determined educational goals.

4.10.2 Public Health Educational Institutions

France is one of countries in Europe and beyond with a lot of medical Universities even if only less than 20 % of French medical students can go till second year of medical schools and has high need of physicians. There are 47 faculties in the field of medicine. List of Medical Universities and Faculties in France: Centre Hôpitalier Universitaire, Faculté de Médecine;

Université Bourgogne, U.F.R. de Médecine;

Université Caen Basse-Normandie, Faculté de Médecine; Université Catholique de Lille, Faculté Libre de Médecine (FLM);

Université Claude Bernard, Faculté de Médecine de Lyon-Sud;

Université Claude Bernard, Faculté de Médecine de Lyon-Nord;

Université Claude Bernard, Faculté de Médecine Grange-Blanche; Université Claude Bernard, Faculté de Médecine Laënnec;

Université d'Aix Marseille - Université de la Méditerranée, Faculté de Médecine de Marseille;

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Université d'Angers, Faculté de Médecine; Université d'Auvergne, Faculté de Medicine Clermont-Ferrand;

Université de Bretagne Occidentale, École de Médecine de Brest;

Université de Limoges, Faculté de Medicine; Université de Lyon 1, Faculté de Médecine Alexis Carrel;

Université de Nice - Sophia Antipolis, Faculté de Médecine; Université de Picardie Jules Verne, Faculté de Médecine;

Université de Poitiers, Faculté de Médecine et de Pharmacie; Université de Reims at Champagne-Ardenne, Faculté de Médecine;

Université Denis Diderot, Faculté de Médecine Lariboisiere Saint-Louis;

Université Denis Diderot, Faculté de Médecine Xavier Bichat;

Université du Droit et de la Sante, Faculté de Medicine Henri Warembourg de Lille;

Université Franche-Comté, U.F.R. des Sciences médicales et pharmaceutiques; Université Francois Rabelais, Faculté de Medicine;

Université Henri Poincaré (UHP) - Nancy I, Faculté de Médecine; Université Jean Monnet - Saint Etienne, Faculté de Médecine Jacques Lisfranc;

Université Joseph Fourier, Faculté de Medicine de Grenoble;

Université Louis Pasteur - Strasbourg, Faculté de Médecine;

Université Montpellier I, Faculté de Médecine de Montpellier –Nîmes;

Université Nantes, Faculté de Médecine; Université Paris Nord, U.F.R. de Médecine et de Biologie Humaine "Leonard de Vinci";

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Université Paris Val de Marne, Faculté de Médecine de Créteil; Université Paris-Sud, Faculté de Medicine;

Université Pierre et Marie Curie, Faculté de Médecine Broussais Hotel-Dieu;

Université Pierre et Marie Curie, Faculté de Médecine Pitié-Salpêtrière; Université Pierre et Marie Curie, Faculté de Médecine Saint-Antoine;

Université René Descartes, Faculté de Médecine Cochin Port-Royal; Université René Descartes, Faculté de Médecine Paris Ouest;

Université René Descartes, Faculté Necker-Enfants Malades; Université René Descartes, U.F.R. Biomédicale des Saints Pères;

Université Rennes I, Faculté de Médecine;

Université Rouen, U.F.R. Médecine;

Université Scientifique et Medicale de Grenoble, Faculté de Médecine;

Université Toulouse III - Université Paul Sabatier, Faculté de Médecine Toulouse - Rangueil; Université Toulouse III, U.F.R. Sciences Médicales de Toulouse-Purpan;

Université Victor Segalen, U.F.R. 1 - Faculté de Médecine Paul Broca;

Université Victor Segalen, U.F.R. 2 - Faculté de Medicine Hyacinthe Vincent;

Université Victor Segalen, U.F.R. 3 - Faculté de Médecine Victor Pachon;

4.10.3 University Program in Public Health – both Undergraduate and Postgraduate

The professional programs in medicine, dentistry and pharmacy all begin with a common year of health-related study (première année commune aux etudes de santé). After the first year, students must sit for a competitive examination. This limits the number of students

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

eligible for further medical, pharmaceutical and dental study. Medical study is offered at universities and is grouped into three cycles. The first medical cycle (premier cycle en médicine) requires two years of study, one of which is the common year.The second cycle (deuxième cycle en médecine) requires four years of study. The third cycle of medical study varies in length depending on the program chosen. Students that follow the general program complete a three-year residency (résidanat) and defend a thesis to earn le Diplôme d’État de Docteur en Médecine (State Diploma of Doctor of Medicine). This allows the holder to practice general medicine.

4.10.4 Continuing Education, LifeLong Learning

The 2004 Law entitles all employees to access a minimum of 120 hours of training/education over a 6 year period (20 hours/year) during working time or free time. The trainings are entirely financed by the employer. Also, in 2014 France started the reforming process in lifelong education, so the trainings for employees are the obligated. This rule is mandatory for healthcare providers.

4.10.5 Public Health Professionals’ Certification (Legislation)

Medical regulatory authority in France that evidence the qualifications of doctors who qualified in France and who need to provide health services is Conseil National de L'Ordre de Médecins.

4.10.6 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

The Department of Information and Communication Technology in Education (SDTICE) is in charge of coordinating IT development in education. At regional level, the académies, regional structures of the Ministry of Education, are in charge of implementing national directives and policies. Some of programmes in public health are online. The special difficulty to completely organize distance learning in public health is the need of practice for students.

4.10.7 Expenditure and Economics

Education is a priority in France, with 6% of the GDP is marked for education.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

From the total expenditure, about 12% went on pre-primary education, 21% on primary, 22% on lower secondary, 1% on post secondary, while 25% on tertiary.

4.10.8 Challenges and Future Perspectives

French universities are in the process of reorganising themselves into massive local federations of existing universities and institutes of higher education, known as PRES - or Pôle de recherche et d'enseignement supérieur – higher education and research poles. There is a twofold aim in this; firstly to save money, by merging some of the administrative structures currently duplicated in each university or institution. Secondly to make French universities more "visible" on the international stage, and hopefully, by bringing together under a single umbrella research laboratories currently belonging to different universities,boost the ranking of French universities in international league tables. 4.11 Germany

4.11.1 The Educational System, Structure and Management, Students Demographics, Legislation

General information:

Germany has a federal system of government which grants its 16 member states a high degree of autonomy in education policy. The Federal Ministry of Education and Research in Berlin has a role in funding, financial aid, and the regulation of vocational education and entry requirements in the professions. Most other aspects of education are under the authority of the individual states.

A federal law, the ‘Hochschulrahmengesetz’ provides an overarching legal framework for higher education. A coordinating body, the ‘Standing Conference of the Ministers of Education and Culture’ facilitates the harmonization of policies among states. Regulations and laws are consistent in many areas, but there can still be considerable differences in key areas. In the recent past, for instance, the length of the secondary education cycle varied from state to state. And different political approaches to tuition fees in different states meant that students in some states were paying € 1,000 (USD $ 1,100) in annual fees while their peers across state lines studied for free. Elementary Education:

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Compulsory education in Germany starts at age six, and, in most states, lasts for nine years. Elementary education is the only stage in German education where all students study at the same type of school. From grades 1 to 4 (grades 1 to 6 is some states), almost all German pupils attend Foundation school, where they study the same basic general subjects. At the end of this foundation cycle, students move on to different types of lower secondary schools.

Secondary Education: The secondary education system includes multiple programs at both the lower secondary and upper secondary levels. These programs emphasize either vocational skills or preparation for tertiary-level education, depending on the track. Lower-Secondary Education – Vocational Track: Lower-secondary education along the vocational track imparts basic general education and prepares students for entry into upper-secondary vocational programs. The two most common school types in this track are the ‘Hauptschule’ and the more popular ‘Realschule’.

 ‘Hauptschul’ programs usually end after grade 9 and conclude with a certificate of completion of ‘Hauptschule’.

 Programs offered at the ‘Realschule’ are academically more demanding and last until grade 10. Students graduate with a certificate of the completion of ‘Realschule’, sometimes also called ‘Intermediate maturity’. This certificate gives access to a wider range of vocational programs and also allows for access to university-preparatory upper-secondary education. Upper-Secondary Education – The Vocational ‘Dual System’: Germany has a variety of different vocational programs at the upper secondary level. One subset of these programs is similar to programs in the general academic track in that students receive full-time classroom instruction. The most common form of secondary vocational education, however, has a heavy focus on practical training. More than 50 percent of German vocational students learn in a work-based education system. This so-called ‘dual system’ which combines theoretical classroom instruction with practical training embedded in a real-life work environment, is often viewed as a model for other nations seeking to address high rates of unemployment, particularly among youth. In times of high youth unemployment in many OECD countries, Germany has the second-lowest

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

OECD youth unemployment rate after Japan – a fact often attributed to the dual system.

Students in the dual system are admitted upon completion of lower-secondary education. The system is characterized by ‘sandwich programs’ in which pupils attend a vocational school on a part-time basis, either in coherent blocks of weeks, or for one or two days each week. The remainder of students’ time is devoted to practical training at a work place. Companies participating in these programs are obligated to provide training in accordance with national regulations, and to pay students a modest salary. The programs last two- to three-and-a-half years, and conclude with a final examination conducted by the responsible authority in the field, often regional industry associations like the Chambers of Industry and Commerce and Chambers of Crafts. The final credential awarded to dual system graduates is typically a formal, government-recognized qualification certifying students’ skills in regulated vocations. In 2015, there were 328 such official vocations with titles ranging from ‘carpenter’ to ‘tax specialist’ to ‘dental technician’ or ‘film and video editor’.

Many vocational schools also offer students a pathway to tertiary education via double qualification courses. Students who take this pathway earn a ‘university of applied sciences maturity certificate’, which qualifies them for access to a subset of higher education institutions, the so-called universities of applied sciences, as well as regular universities in a small number of states. The theoretical part of this program is commonly completed after 12 years. Upper Secondary Education – University-Preparatory Education:

Abitur programs (university-preparatory study) predominantly take place at a dedicated type of school called the ‘Gymnasium’. Study at this school usually begins directly after elementary school. Programs include a lower-secondary phase (until grade 10) and an upper-secondary phase of two or three years. Together, lower, upper, and secondary education typically last 12 or 13 years. The Gymnasium curriculum is designed to ensure ‘maturity’ or readiness for higher education based on mandatory study of core subjects including: languages, literature and arts, social sciences, mathematics, and natural sciences. The program concludes with the rigorous written and oral final Abitur examination, which is overseen by the ministries of education of the states, most of which mandate standard content for one uniform

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

examination taken by all students. After successful completion of the exam, students receive the ‘Certificate of general university maturity’, a credential that gives graduates the legal right to study at a university. Since study in Germany is also mostly free, this may sound like an egalitarian educational utopia. In reality, however, admission to universities can be competitive. The final Abitur grade determines how quickly students get admitted to popular programs that have a fixed number of available spaces (numerus clausus). According to the German Foundation for University Admissions, the waiting period for admission into medicine programs was, as of 2015, seven years for students with lower grades. Tertiary Education:

In recent years, Germany has experienced increased participation rates in university education in general, and a growth of enrollments at private institutions in particular. The German Office of Statistics reported that the number of newly registered students (excluding foreign students) in the first semester of a degree program increased by more than 34 percent in the last decade – from 290,307 in 2005 to 391,107 in 2015. According to the statistics provided by the German Science Council, the total number of students attending German tertiary institutions in the fall of 2016 is 2,718,984. Despite these gains, however, Germany still has below-average tertiary education entry and graduation rates compared to other industrialized countries. According to the OECD, 53 percent of young German nationals entered a tertiary education program in 2013, compared to an average of 60 percent among OECD member states. The depressed entry rate is attributable, at least in part, to Germany’s secondary vocational education system. Graduates from secondary-level German vocational programs – such as nursing, for instance – can legally work as entry-level professionals. In other countries, employment in these fields typically requires a tertiary degree. While this fact relativizes the comparatively low entry rate at the tertiary level, however, it does not fully account for Germany’s graduation rates, which remain below average: Only 35 percent of all first-time tertiary German students (excluding foreign students) graduated with a degree, placing Germany in the third to last place in one 2015 OECD report.

Types of Institutions:In addition to non-tertiary higher education and government schools, Germany currently (2016) has 396 state-recognized higher education institutions. The institutions are of two types: 181 universities and university-

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

equivalent institutions, including specialized pedagogical universities, theological universities, and fine arts universities; and 215 so-called universities of applied sciences (Fachhochschulen). The main difference between the two types of institutions is that the first set of institutions arededicated to basic research and award doctoral degrees, whereas Universities of Applied Sciencesare more industry-oriented and focused on the practical application of knowledge. Both institutions award Bachelor and Master degrees, but Universities of Applied Sciences do not have the right to award doctoral degrees. Their programs usually include a practical internship component and tend to be concentrated in fields like engineering, business, and computer science. A further distinction lies in the admission requirements: Whereas a certificate of general university maturity is required for unqualified access to universities in most states, study programs at Universities of Applied Sciences can be entered with a university of applied sciences maturity certificate earned in the vocational track. In terms of enrolments, more than 60 percent of students in 2015 (1,756,452) studied at universities, while about one third of students (929,241) attended Universities of Applied Sciences.

4.11.2 Public Health Educational Institutions

The academization of health professions others than physicians in Germany for the most part takes place at Universities of Applied Sciences. Between 1985 and 2002 the German Federal Government committed to public health capacity building by com-missioning national initiatives involving graduate scholarship programs abroad and research programs that established five regional Public Health Research Networks. International evaluation of these centers produced a mixed assessment; problems were compounded by lack of infrastructure and sustainable funding to continue supporting academic career development and research. Some of these networks have been able subsequently to continue research programs, although at a less ambitious level, and Germany still ranks low in the European region regarding public health research intensity. In the late 1980s, eight German universities started a master’s degree program in Health Sciences and in 1991 the University of Bielefeld established the first German School of Public Health. Later, the responsible ministry funded a suite of grants programs on prevention, rehabilitation, patient oriented research, and health economics with the stated objective to support capacity building in these fields.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.11.3 University Programs in Public Health both Undergraduate and Postgraduate

The Universities of Applied Sciences offered 270 bachelor’s degree courses and 200 master’s degree courses in the field of health, as of October 2014. Among these were courses in health sciences/public health, social work, nursing, therapeutic professions, nutrition, physical education, health economics or vocational education. Moreover, other degree courses, for example in engineering, can be geared towards health-related professions. Several Universities of Applied Sciences have established faculties or research priorities on health sciences/public health emphasizing a population-related perspective on health. The search on the German website ‘hochschulkompass.de’ identified 38 degrees in medicine, 20 degrees in the health sciences, 15 degrees in public health and two degrees combining public health and the health sciences. These degrees were offered at 58 universities in Germany. Investigation of the degree programs rendered 26 Global Health Education (GHE) activities, and seven additional GHE activities not directly related to the degree programs were found. All 33 GHE-related activities are provided by or in cooperation with 18 German universities. Out of those activities, 14 (42 %) are offered as part of medical schools’ curriculum. Semester-long, elective seminar series represent the majority of those curricular activities (n = 10, 30 %).

The medical faculty of the University of Hamburg offers a six semester-long elective course that integrates GH into a broader curriculum of intercultural competence and international medicine. The final year elective ‘Tropical Medicine and Global Health’ at the University of Würzburg constitutes another opportunity for medical students to incorporate GH into their curriculum by combining clinical and project work. Two medical schools have mandatory GHE offered as a lecture on public health at the University of Bonn that includes GH topics and a seminar series on GH ethics at the University of Erlangen-Nuremberg. The medical faculty of the University of Giessen employs a voluntary GH-focused curriculum (Schwerpunktcurriculum ‘Global Health’), which is a combination of different teaching formats such as lectures, seminars and studies abroad.

The student-led ‘Globalisation and Health Initiative’ (GandHI) at the University of Aachen as well as the University of Heidelberg’s Society Georg Forster for Global Health offer

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

extracurricular GH activities for medical students. Other voluntary extracurricular activities open to students of all disciplines are the ‘Global Health Student Group’, the ‘Global Health Summer School’, the ‘Global Health Conference’ in Berlin and the ‘Summer Academy – Global Health and Tropical Medicine’ at the Medical Mission Institute Würzburg.

Overall, there are GHE opportunities at 13 of 38 (34 %) medical schools in Germany. In addition to medical schools, six universities with health-related degree programs like public health and health sciences offer GHE activities: five GH-specific modules (15 % of total GHE activities) and four modules (12 %) partly addressing GH. Furthermore, an elective GH lecture series and an elective seminar series for Master of Arts and PhD programs, respectively, are offered by the Department of Development Economics at the University of Göttingen. The University of Freiburg will offer the first interdisciplinary Master of Science program in GH starting in October 2016. Overall, some universities offered detailed online course descriptions, whereas others lacked accessible and updated information, requiring further investigation through direct contact. 4.11.4 Continuing Education, Life Long Learning

More and more people are taking advantage of continuing education programmes. For the first time in about 15 years there was a significant rise in the percentage of people in continuing education, up to 49% in 2012. Lifelong learning is accorded a high degree of significance from an educational and employment policy point of view. In 2012 the Federal Government and the federal states have set themselves the objective of achieving 50 percent participation of the working age population in continuing education and training by the year 2015, measured by the Adult Education Survey (AES). There is a further focus on increasing participation by educationally disadvantaged groups. Alongside continuing education and training as defined in the German AES reporting system, there are, however, other forms of adult learning. Forms of learning in the AES:

The AES is a “data collection on the participation and non-participation of adults in lifelong learning”. The conducting of such a survey by the member states of the European Union became compulsory for the first time in 2011/12. In Germany, a representative sample of

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

the population aged 18-64 was surveyed in 2012. A total of 7,099 persons were asked about their learning activities in the twelve months prior to the interview.

The AES differentiates three forms of learning:

 Formal education takes place within a national educational system comprising schools, the dual system of vocational education and training (VET) and tertiary education. The certificates that can be achieved are included in the respective National Qualifications Framework (NFQ; regular educational programmes). Educational programmes are hierarchically structured and are required to have a minimum duration of six months. Alongside the schools, the dual VET system and the institutions of higher education, advanced training that leads to a qualification (such as master craftsman or technician) also constitutes part of formal education.

 Non-formal education comprises learning activities that take place outside the formal educational system. It involves structured activities that either do not result in a certificate or else in a certificate that is not localised in the National Qualifications Framework (NFQ). This includes all activities conducted within the scope of a teaching-learning relationship, such as courses, seminars, conferences, distance learning and private lessons. Pre-planned training and learning at the workplace, e.g. in circumstances where line managers act as tutors, also forms part of non-formal learning.

 Informal learning encompasses all activities that explicitly pursue a learning goal (i.e. are intentional) but are less structured. Informal learning includes learning activities outside teaching-learning settings (use of teaching materials, observation of other persons, learning or quality circles) as well as learning activities with a coach, expert or similar that are not planned in advance such as spontaneous instructions provided by colleagues in the case of urgent problems at the workplace. Informal learning can occur almost anywhere, e.g. in the family, with friends or at the workplace. Participation of workers in different forms of learning:

The total rate of worker participation in intentional learning (formal, non-formal and informal) is 73 percent. Because many workers make use of more than one form of learning, the overall participation rate is lower than the total of the participation rates in the individual forms of learning. Participation in non-formal learning is 56 percent, the

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

highest rate. Informal learning is undertaken by 48 percent, whereas four percent of workers participate in formal education and training. In the case of persons aged 18-24- years, however, formal learning mostly constitutes an initial phase of education that is continuing. Narrowing the debate on adult learning to non-formal education and training (as currently predominant in Germany) excludes a considerable part of adult learning.

4.11.5 Public Health Professionals Certification (Legislation)

The majority of certifications in public health can be achieved in the Tertiary Education with the Bachelor and Master degree (cf. 3. University programs in Public Health both undergraduate and postgraduate). Another possibility are programs of officially licensed institutions. For example the School of Public Health, University of Bielefeld offers summer school courses which are certified by ECTS and continuing education by the Ärztekammer Westfalen Lippe. Three professional societies (German Association for Medical Informatics, Biometry and Epidemiology [GMDS], German Network for Evidence-based Medicine [DGSMP The German Region of the International Biometric Society [IBS-DR]) established a ‘certificate’ of competence in epidemiology based on a portfolio of pertinent achievements and an oral qualifying examination. GMDS offers three further certificates: in Medical Informatics, Medical Biometry and Medical Documentation.

4.11.6 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

E-learning programs have been offered and developed in Germany especially in the teaching and training of medicine. A well-known example is the HEICUMED Program in Heidelberg. The curriculum of the medical doctrine has been newly developed using the "Harvard New Pathway in Medical Education" and modern e-learning procedures. Role of the computer in new courses:

 Search facilities and information sources o Booklet (Library)

o Electronic journals library o Electronic reference books

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o Internet: Google, Wikipedia

 ‘Problem Packs’: references to literature, tutorials, videos and professionals working to solve a given problem

 Contact medium

o Discussion forums o Chat

o Mail

 Information and education medium

o Tutorials (all types of interaction) o Videos

The Center for Technology-Enhanced Learning (ZML): is the central point of contact for the conceptual design, development, implementation and evaluation of online and blended- learning learning programs. As a provider of education, we develop technology-based teaching and learning solutions that are accessible anytime and anywhere, thus addressing teachers and students across a wide range of educational contexts. By means of specifically tailored e-learning services we provide advice and support with regard to the implementation of media-enhanced teaching formats, such as MOOCs (Massive Open Online Courses).

 MOOCs are a current trend in higher education: Universities are opening up access to their courses for a global audience and millions have signed up. In the US, MOOCs are already a permanent feature of academic teaching. In Germany, too, the number of these freely accessible and flexible online courses is growing.

 MOOCs combine knowledge transfer with interactive elements aimed at fostering competencies. They include video clips, quizzes and tasks and provide forums for discussion and mutual exchange. Depending on the type of platform used, there is the possibility of purposefully integrating further inputs, e.g. live chats or video conferences.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 With its eLearning services, ZML offers a wide range of support options related to the production of MOOCs and other video-based teaching. The ZML offers advice and support in the production and implementation of online courses. The Global Health Network offers in his Global Health Training Centre online courses among others in English and German, which are also certified. LRSMed: Learning Resource Server Medicine (Medical E-Learning Software on the Web):

 The offers on the web for training and further education in medicine have been extended dramatically during the last years. LRSMed offers a service to simplify the search for the right applications and resources.

 The LRSMed offers search capabilities for multimedia learning software modules, which are deployed in the World Wide Web. These modules have been described in different manners, e. g. the specialism and application type.

 At the moment, 1818 e-learning software modules are free of charge.

4.11.7 Expenditure and Economics

Expenditure on education rose by 4.6 billion Euro to 247.4 billion Euro between 2010 and 2012, the equivalent of 9.3 % of GDP. Government expenditure on education, total (% of government expenditure) in Germany was 11.22 as of 2012. The Expenditure on tertiary education (% of government expenditure on education) in Germany was 26.78 as of 2012. Its highest value over the past 14 years was 28.13 in 2011, while its lowest value was 23.25 in 1998. Public Health education takes place in majority in the tertiary education.

4.11.8 Challenges and Future Perspectives

Concerns about fragmentation of public health in academia in Germany are compounded by several factors:

 Lack of consensus on terminology: and lack of clarity about the relative roles and responsibilities of public health, social medicine, prevention and health promotion, and medical sciences.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Inadequate academic basis: generally there is only limited public health presence in the medical faculties and there is controversy in Germany about the optimal degree of connectivity between clinical medical and public health faculties. Appropriate connectivity of public health with other key areas (social and labour policies, education provision, agriculture, transport and the built environment, for example) also needs to be strengthened as discussed elsewhere in this statement. Public health research attracts little funding by comparison, for example, with basic biosciences. Moreover, it has been found difficult to justify the value of the interdisciplinary research inherent in public health to funding bodies that have traditionally focused on specific scientific disciplines.

 Uncertain impact: published outputs often have only limited impact – sometimes because of the methodological challenges – compared with other areas of science. However, an important distinction must be made between impact in the sense of citation by other publications and impact in society. Developing better indicators of the impact of research is itself an important research area. The research performance issues are not confined to Germany. It has been observed that, by contrast with some other research disciplines, data sharing is not yet the norm within the public health community. This lack of data sharing needs to change or it will limit both research progress and its translation to impact for health benefits.

 Limited career development: there are comparatively few obvious career development opportunities in public health, whether in universities, national organizations, international organizations located in Germany or industry. The “Öffentliche Gesundheitsdienst / Public health service” (ÖGD), on the other hand, is constantly looking for applicants. However, there are many important careers in government and public agencies where public health graduates use their skills but the position may not be labelled as public health. There are also possibilities to provide academic career paths for public health professionals in other disciplines and departments, for example by integrating public health teaching and research in schools of political sciences and social sciences, facilitating interdisciplinary approaches and collaborations. Furthermore, consideration should be given to joint appointments between academia and public health institutions, and with NGOs. There is need to increase visibility about what public health entails. Nonetheless, and notwithstanding these multiple concerns, Germany can capitalize on significant strengths to address the new opportunities and challenges in public health: unparalleled financial resources, a strong tradition of medical research and

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

innovation, equally strong research in sociology and political science, critical mass of technical expertise, a new commitment to epidemiology and increasing recognition of global responsibilities. These strengths can serve to promote scientific excellence and a firmer link between academia and practice.

4.11.9 Greece

4.11.10 Educational System

Stages of the education system

Compulsory education in Greece lasts for ten years and extends from the age of 5 to the age of 15 years. In particular, the Greek educational system is mainly divided into three levels: primary, secondary and tertiary, with an additional post-secondary level providing vocational training.

Primary education is divided into pre-primary school lasting one or two years and primary school spanning six years (ages 6 to 12).

 Pre-primary education in Greece begins at the age of four (4) when children are allowed to enroll in Nipiagogeia (Kindergartens). Attendance is compulsory for all five (5) year-old children.

 Primary Education is the next stage and comprises of the compulsory six-year attendance in Dimotika Scholeia (Primary Schools). It concerns children in the age range of 6-12 years. Since school year 2016-2017, a Single Type of All-Day Primary School is established. Secondary Education includes two cycles: the first one is compulsory and corresponds to Gymnasio (Lower Secondary School) and the second one is the optional Geniko or Epaggelmatiko Lykeio (Upper Secondary School).

 Gymnasio (Gymnasium) is a three-year school, which provides general education. It covers ages 12-15 and it is a prerequisite for enrolling and attending General or Vocational Upper Secondary Schools. In parallel with day Gymnasium, Esperino Gymnasio (Evening Lower Secondary Education School) operates, in which attendance starts at the age of 14.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Upper Secondary Education is the second tier of secondary education and lasts also for 3 years. Pupils enroll at the age of 15. It is worth noting again that it is non- compulsory and it is offered in two different types: a) general secondary education – offered in Geniko Lykeio (General Lyceum); it involves a three-year programme, which includes both common core subjects and optional subjects of specialization. b) vocational secondary education – offered in Epaggelmatiko Lykeio (Vocational Lyceum). The latter offers two cycles of studies, which belong to the formal educational system: a. the secondary cycle and b. the optional post-secondary cycle of studies, the so-called “apprenticeship class”, a scheme which involves combined school and workplace courses. Parallel to day schools, Esperina Genika Lykeia (Evening General Lyceums) and Esperina Epaggelmatika Lykeia (Evening Vocational Lyceums) also operate. These involve a four-year attendance and the minimum age for enrolment for the latter is the age of 16.

Higher education constitutes the last level of the formal education system and comprises of the Panepistimio (University) and Technological sectors. The University sector includes Universities, Polytechnics and the School of Fine Arts. The Technological sector includes the Technologika Ekpaideftika Idrymata (Technological Education Institutions – TEIs) and the Higher School of Pedagogical and Technological Education (ASPETE). Undergraduate courses typically last for 4 years for most scientific sectors while they last five years at Polytechnics, other applied sciences (Agronomy, Forestry, Dentistry, Veterinary Medicine, and Pharmaceutics) and certain Art Departments (music studies and fine arts) and six years for Medical School. The postgraduate courses last from 1 to 2 years and doctorates from 3 to 6 years. The duration of studies leading to a TEI degree is four years.

According to article 16 of the Greek Constitution, higher education is publicand no private Higher Education Institutions exist in the country. Branches of foreign universities operate as Colleges (Kollegia), which belong to post-secondary non-tertiary education. In Greece, there are twenty-two (22) University Sector Institutions (Universities, Technical Universities, the Higher School of Fine Arts), including the Hellenic Open University and the International Hellenic University. Moreover, pursuant to Law 3187/2003, the Military Educational Institutions of the Ministry of National Defense offer University level

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

education, while, pursuant to Law 3432/2006, Higher Ecclesiastical Schools operate as Higher Ecclesiastical Academies equal to Universities.Also, there are 14 TEIs throughout the country including ASPETE. By Law 3450/2006, while Merchant Naval Academies are recognised as equivalent to TEIs.

Studies are divided into three cycles, the first, the second and the third one. The first cycle of studies comprises the attendance of a study programme, includes courses corresponding to a minimum of 180 ECTS credits and leads to the award of a diploma / certificate. To the award of a degree (Titlos Spoudon) students should attend a study programme that consists of modules that correspond to at least 240 credits.The second cycle of studies comprises the attendance of a postgraduate programme. This programme includes courses corresponding to a minimum of 60 ECTS credits and leads the award of a Postgraduate Degree (Metaptychiako Diploma Spoudon). The third cycle of studies comprises the attendance of a doctorate study programme. It includes courses corresponding to at least 30 ECTS credits, as well as the thesis preparation. It is concluded within minimum three years duration and leads to the award of a doctoral diploma. Lifelong Learning policy in Greece is part of a wider development plan aiming at giving emphasis to human knowledge, abilities and skills. Within the framework of non-formal education, which can lead to attainment of certifications recognised at national level, structures providing lifelong learning services are as follows:

 Scholes Epaggelmatikis Katartisis – SEK (Vocational Training Schools), which provide non-formal initial vocational training of three-year duration to graduates of compulsory formal education; nevertheless, SEK are gradually being abolished and they will cease to exist at 31-08-2019;

 Institouta Epaggelmatikis Katartisis - IEK (Vocational Training Institutes), which offer non-formal initial vocational training to graduates of formal non-compulsory secondary education, as well as to SEK graduates;

 Kentra Dia Viou Mathisis (Lifelong learning Centers), which provide continuing vocational training, general adult education, vocational guidance and lifelong counseling;

 Kollegia (Colleges), which provide non-formal education to graduates of formal non- compulsory secondary education.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.11.11 Public Health Education and Educational Institutions

Studies in the field of Public Health in Greece: Bachelor:

 Health Visitor (Department of Public Health and Community Health-Unit of Community Health)

o At the Technological Educational Istitute of Athens o Programme duration: 4 years

 Public Health (Department of Public Health and Community Health-Unit of Public Health) o At the Technological Educational Istitute of Athens o Programme duration: 4 years Master:

 Postgraduate programm in Public Health (sub-specializations: Public Health, Community Nursing, Trans-cultural Nursing) o Department of Nursing-National and Kapodistrian University of Athens o Programme duration: 2 years

 Master Assessment and Management of Occupational, Environmental and Medicinal Risk o Medical School- National Kapodistrian University of Athens, Department of Political Science and Public Administration-National and Kapodistrian University of Athens and Department of Social Work-Technological Educational Institute of Crete o Programme duration: 2 years

 Postgraduate program in Public Health (specializations: Public Health General Direction, Public Health towards Chronic Diseases and Health Behaviors, Public Health towards Infections Diseases) o National School of Public Health

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o Program duration: 1 year (full time) or 2 years (part time)

 Postgraduate program in Health Services Administration (specializations: Health Services Management-General Direction, Health Service Management with specialization Economic Assement, Health Service Management with specialization Adminstration of Nursing Servises) o National School of Public Health o Program duration: 1 year (full time) or 2 years (part time)

 Postgraduate program in Occupational & Enviromental Health(specializations: General Direction for Medical School graduates,Enviromental Health) o National School of Public Health o Program duration: 1 year (full time) or 2 years (part time)

 M.Sc. in Public Health (PH) o School of Medicine of University of Patras o Program duration: 1 year and 6 months

 Postgraduate program in Public Health – Health Service Management (specializations: Public Health-Epidemiology, Public Health-Infectious Diseases, Health Services Aedministration)

o Medical School-University of Crete o Program duration: 1 year and 6 months

 MSc in Health Promotion and Health Education o Medical School-National and Kapodistrian University of Athens, Department of Psychology- National and Kapodistrian University of Athens and Department of Public and Community Health of Athens Technological Educational Institute o Programme duration: 2 years

 MSc Environment and Health. Capacity Building for Decision Making

o Medical School-National and Kapodistrian University of Athens o Programme duration: 2 years

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Master in Stress Science and Health Promotion o Medical School-National and Kapodistrian University of Athens o Programme duration: 2 years

 Postgraduate Program in Promoting Mental Health-Prevention of Psychiatric Disorders o Medical School-National and Kapodistrian University of Athens o Program duration: 1 year and 6 months

4.11.12 Expenditure and Economics in Public Health

Public health expenditure, total (% of GDP) of Greece was reported at 4.99 % in 2014. Greece is one of the very few OECD countries that have not adopted the OECD system of health accounts. As a result, the quality and the coverage of the data are very poor. For example, there are no official statistics on the breakdown of public and private aggregate expenditure between the various types of care. In addition, the revisions of GDP result in changes of the shares of total, public and private expenditure as a percentage of GDP. In 2007, health care spending for 2005 was revised from 10.1% to 9.0% of GDP, as compared with the series available one year earlier. Also, private expenditure dropped from 57.2% of total health expenditure to 37.2%. Health care expenditure has increased substantially over the last two decades (1990-2007) in per capita US$ PPP and as a share of GDP. The proportion of total health expenditure has risen from 6.6% in 1990 to 9.6% of GDP in 2007. This figure is above the average of 9.0% in OECD countries and ranks Greece among the ten highest health spenders of the OECD group. Greece spends more on health than Scandinavian countries (Finland 8.2% of GDP, Norway 8.9%, Sweden 9.1%), other Mediterranean countries (Italy spends 8.7% and Spain 8.5%), and countries such as Luxembourg (7.3%) and the United Kingdom (8.4%). In terms of health spending per capita, Greece, with US$ 2727 in 2007 (adjusted for PPP), ranks below the OECD average of US$ 3071. Furthermore, Greece has one of the largest shares of private health expenditure among OECD countries, given that it constitutes 39.7% of total health expenditure. This share ranks Greece as the fifth highest private spender on health after Mexico (54.8%), the United States (54.6%), Republic of Korea (45.1%) and Switzerland (40.7%). The percentage of GDP that Greece allocates for public health expenditure (5.8%) is one of the lowest among

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

OECD countries after Mexico (2.7%), Republic of Korea (3.5%), Poland (4.6%), Slovakia (5.2%) and Hungary (5.2%) (OECD 2009).

Over the past 27 years a continual increase in health expenditure, in both absolute and relative terms, has been observed, although at different rates. The mean average growth rate (MAGR) of total health expenditure in constant prices for the period 2000–2007 was higher than in the periods 1980–1989 and 1990–1999, reaching 7.2%. Moreover, during 1980–2007, the MAGR of total health expenditure was almost double the MAGR of GDP.Another conclusion from the data is that the growth of both public and private expenditure contributed almost equally to the overall growth of health expenditure. Despite the pressure exerted by the EU on Greece since 2000 to reduce public expenditure, to maintain budget discipline and to avoid excessive deficits in order to fulfil the Maastricht criteria and the provisions of the Stability and Growth Pact, the health care expenditure growth rate continued to rise. This trend is expected to be reversed in the light of the measures taken by the Greek government in 2010 with the aim of confronting the country’s huge public sector debts. Furthermore, it is obvious that during these years the public system has been hospital- centred, with secondary health care services accounting for over 52% of public spending on health. In contrast, the greatest proportion of private health spending has been allocated to primary and dental care. This is further documented by the Survey of household budgets, conducted by the NSSG in 2005. According to the results of the survey, the average monthly amount spent on health care services per household was €128.17, representing 7.15% of total household expenditure (€1792.28). Moreover, 31.1% of household health expenditure was devoted to dental services (€39.91), 23.3% to physicians’ consultations (€29.85), 19.9% to pharmaceutical products (€25.54), 11.3% to paramedical services (€14.43), 10.3% to private hospital services (€13.25) and 4% to public hospital services (€5.19) (NSSG 2005).

4.11.13 Challenges and Future Perspectives

The public health field currently is experiencing a shortage in workers. The greater challenge of public health professionals try to prevent people from getting sick or injured in the first place. Public health promotes and protects the health of people and the communities where they live, learn and work. More specific, public health scientists promote wellness by encouraging healthy behaviors.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

From conducting scientific research to educating about health, people in the field of public health work to assure the conditions in which people can be healthy. That can mean vaccinating children and adults to prevent the spread of disease;or educating people about the risks of alcohol and tobacco. Public health sets safety standards to protect workers and develops school nutrition programs to ensure kids have access to healthy food.

Generally, Public health tracks disease outbreaks, prevent injuries and shed light on why some of us are more likely to suffer from poor health than others. The many facets of public health include speaking out for laws that promote smoke-free indoor air and seatbelts, spreading the word about ways to stay healthy and giving science-based solutions to problems. The most important thing is that public health saves money and improves the quality of people's life. 4.12 Hungary

4.12.1 History

The first university department in the field of hygiene in Hungary was established by Jozsef Fodor at the Medical Faculty in Budapest in 1874. The Hungarian National Institute of Hygiene was subsequently founded in 1925 with the financial support of the Rockefeller Foundation and a health education network was established in 1926 based on the Decree of the Minister of Public Welfare and Labour. During the last 85 years, the names and organizational structure of the Institute were changed many times. Departments of Hygiene were created in the country’s medical schools as early as the 1920s. These departments were involved almost exclusively in the training of medical doctors in sanitation and control of communicable diseases, while few departments of social medicine—created mainly after World War II in the era of “building socialism”—delivered courses on health care organization and management.

4.12.2 Public Health Education at the University of Debrecen

Within the framework of the Health Services and Management Program of the Hungarian Government, and with the aid of a World Bank loan (1993-2000), the project of establishing a School of Public Health at the University of Debrecen began in 1996, serving as a foundation for the development of the first Faculty of Public Health in Hungary. The Faculty status was obtained by the decision of the Hungarian Government on the first of

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

December, 2005, upon the unification of the School of Public Health, the Department of Preventive Medicine, the Department of Family Medicine and the Department of Behavioural Sciences of the University of Debrecen. Formation of the independent Faculty of Public Health at the University of Debrecen—presently uniting 14 different faculties— was preceded by a ten-year period of development. Between 1997 and 2005, establishment and launching of five different postgraduate and one graduate training program as well as the establishment of a doctoral program was carried out by the teaching staff with the effective support of the University of Debrecen and its Medical and Health Science Centre. As a result of these efforts, the Faculty became a unique, internationally recognized and competitive training centre in Hungary. In 2007, in accordance with the Bologna process, the Faculty established and launched its bachelor’s and master’s training programs in the field of public health and health sciences. Today, with its two bachelor’s (BSc in Public Health, BSc in Physiotherapy), four master’s training programs (MScPH with four specialties: public health officer, epidemiology, environmental and occupational health, health promotion; MSc in Health Psychology; MSc in Health Policy, Planning and Financing; and MSc in Complex Rehabilitation) and six postgraduate courses (Public Health, Environmental Health, Health Promotion, Epidemiology, Health Care Quality Assessment and Improvement, Hospital Hygiene and Infection Control), the Faculty of Public Health offers a rich variety of learning experiences. There are also two doctoral programs available since 2002. The mission of the Faculty of Public Health of the University of Debrecen as the center of public health education in Hungary is to improve the health of the population by developing and maintaining internationally recognized high quality training programs, complying with the training needs of public health and health care institutions, both at the graduate and postgraduate levels; pursuing excellence in research; and providing consultancy services. The Faculty of Public Health organizes and carries out its training activities according to the professional guidelines of ASPHER.

4.12.3 Public Health Education at the Semmelweis University

Beyond the programs provided by the Faculty of Public Health of University of Debrecen, students may find public health education programs by two other faculties in Hungary. The Faculty of Health Sciences of Semmelweis University in Budapest was founded in 1975 with the mission of training highly accomplished, skilled, committed and open minded health care professionals. This was the first school in Hungary that trained dietitians, health visitors, physiotherapists, hygiene inspectors, vocational teachers and ambulance officers. Today the Bachelor of Science (BSc) in Health Care and Prevention with different specializations offers learning experiences for students in Hungarian.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.12.4 Public Health Education at the University of Pécs

The Faculty of Health Sciences was established as a part of the Medical University of Pécs by the Minister of Health and Social Welfare in 1989 in order to offer courses for health care specialists leading up to the BSc degree. Today, after the integration process leading to the University of Pécs, the Faculty of Health Sciences is an independent organizational unit among the ten faculties of the University. Public health education in Hungarian is available through the Bachelor of Science (BSc) in Health Care and Disease Prevention, and Master (Msc) in Public Health. 4.13 Ireland

4.13.1 Educational System

Education is compulsory for children in Ireland from the ages of six to sixteen or until students have completed three years of second-level education.

Higher Education in Ireland is provided mainly by 7 Universities, 14 Institutes of Technology, including the Dublin Institute of Technology and 7 Colleges of Education. In addition, a number of other third level institutions provide specialist education in such fields as art and design, medicine, business studies, rural development, theology, music and law. The Higher Education Authority (HEA) is the statutory planning and development body for higher education and research in Ireland. The HEA has wide advisory powers throughout the whole of the third-level education sector. In addition it is the funding authority for the universities, institutes of technology and other designated higher education institutions.

Further Education covers education and training which occurs after second level schooling but which is not part of the third level system. There are number of providers of Further and Adult Education and Training and a wide variety of schools, organisations and institutions, are involved in the delivery of continuing education and training for young school leavers and adults. Ireland has increased its attainment levels, which are higher than the OECD average: 85% of 5-34 year-olds have attained secondary education(OECD average of 82%); 47% have attained tertiary education (OECD average of 39%). Attainment level in vocational education and training among 25-64 year-olds is 13%.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Expenditure on education institutions at all levels is 6.4% of GDP. In 2012/2013, 196.000 students were enrolled in higher education institutions.

4.13.2 Public Health Education and Educational Institutions

Higher education institutions in Ireland offer several bachelor and master programmes in public health or related subjects. Bachelor programmes are offered for example by the University College cork (Bachelor in Public Health Sciences or in Environmental Science), by the Dublin City University (Bachelor in Environment Science & Health or in Health and Society), by the Trinity College Dublin (Bachelor in Human Health and Disease) or by the National University of Ireland (Bachelor in Health and Safety Systems).

Master programmes are offered for example by the University College Cork (Master in Public Health, in Occupational Health, or in Dental Public Health), the University College Dublin (Master in Public Health) or the Trinity College Dublin (Master in Healthcare Infection Management, Master in Global Health). NUI Galway offers a Master in Health Sciences (Public Health Nursing). The University College Cork offers some of these masters also as fully online programme. The full-time Master programmes often have a duration of one year.

Beside bachelor and master programmes, several postgraduate programmes are available. For example, the University of Limerick offers a one-semester postgraduate certificate in Global Health & Development. The University College of Cork offers a one-year postgraduate diploma (PG Dip) in Public Health. The University College Dublin offers a one- year Graduate Diploma in Public Health Nursing for nurses. NUI Galway offers a one year postgraduate Diploma in Health Sciences (Public Health Nursing). The Royal College of Physicians in Ireland offers a four-year higher specialist training in public health medicine for physicians (which requires to get a Master in Public Health within its first year). The Public Health Agency also offers a four-year public health training.

4.13.3 Expenditure and Economics in Public Health

Public health expenditure, total (% of GDP) of Ireland was reported at 5.1% in 2014.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

From 2000 to 2009, the Irish public healthcare spend more than doubled in real terms to €15.5 billion per annum. Spending is mainly directed towards diagnostics and treatment services for diseases and injury. Chronic diseases and their risk factors are major drivers of healthcare costs, as well as associated economic losses.

There are eight Departments of Public Health covering the Republic of Ireland, each providing Public Health expertise and services locally and nationally.Departments of Public Health professionals provide health protection services, advocate and contribute to health improvement, and participate in health service development. Each Department is led by a Director of Public Health who is also the regional Medical Officer of Health. Departments of Public Health have a statutory responsibility to protect health under the Medical Officer of Health function. Health protection involves risk assessment, identification and implementation of solutions, and most importantly communication with the public and professionals. Department of Public Health staff work closely with a variety of professionals within the HSE, especially the Health Protection Surveillance Centre and with other agencies including Local Authorities, Government Departments, the Environment Protection Agency, and Public Health England.

4.13.4 Challenges and Future Perspectives

Higher education institutions in Ireland offer a broad range of programmes to get training in public health and related fields, including bachelor and master programmes, postgraduate certificates, postgraduate diploma, and higher specialist training. The Healthy Ireland Framework for Improved Health and Wellbeging 2013 – 2015 stresses the need to update and modernize public health legislation to meet 21st Century requirements was identified, i.e., move to risk-based, modulated responses, dealing with all threats and not just communicable disease threats, as is required under International Health Regulations (IHR) and the upcoming EU Cross Border threats decision.

Within Action 4.9, the Healthy Ireland Framework suggests to promote a skilled, diverse, cross-trained prevention workforce through training and continual professional development for primary care workers, health improvement and promotion staff, public health, educationalists (including those working in the early years sector) environmental health, health protection and staff in other sectors.

Within action 4.7, the Healthy Ireland Framework suggests to further support the roles of local health and social care staff who work in community settings, such as public health

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

nurses; devise ways to leverage their expertise in improving the health of local communities and develop supports for this. 4.14 Italy

4.14.1 Educational System

The Italian education system is mainly a public State system. Private subject and public bodies can establish education institutions. Such non-State schools can be either equal to State schools (called paritarie schools) or merely private schools. These latter cannot issue qualifications. Stages of the education system

The Italian education and training system includes preprimary (ECEC 3-6), primary, secondary (lower and upper), post-secondary and higher education. Early childhood education and care (ECEC)

 ECEC for children aged less than 3 years is offered by nursery schools (nidi d’infanzia) and it is not part of the education system. Local authorities and private subjects offer nursery schools according to regional regulations.

 ECEC for children aged from 3 to 6 years is available at preprimary schools (scuole dell'infanzia). Preprimary education is part of the education system and is not compulsory.

Compulsory education starts at 6 years of age and lasts for 10 years up to 16 years of age. It covers the whole first cycle of education and two years of the second cycle. The last two years of compulsory education can be attended either in an upper secondary school or within the regional vocational education and training system. Compulsory education can be undertaken at either State schools or non-State, publicly subsidised schools (scuola paritaria) or, subject to certain conditions, at merely private schools or through home education. Compulsory education is free. In addition, everyone has a right and a duty (diritto/dovere) to receive education and training for at least 12 years within the education system or until they have obtained a three-year vocational qualification by the age of 18.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 First cycle of educationis compulsory and is made up of primary and lower secondary education. o Primary education (scuola primaria) starts at 6 years of age and lasts 5 years.

o Lower secondary education (scuola secondaria di primo grado) starts at 11 years of age and lasts 3 years.

Within the first cycle, students pass from one level to the next without exams. At the end of the first cycle of education, students who pass the final state examination progress directly to the second cycle of education, the first two years di which are compulsory.

 Second cycle of educationstarts at the age of 14 and offers two different pathways. The first two years of the second cycle of education are compulsory. o Upper secondary school education (scuola secondaria di secondo grado) is both general (licei) and vocational (technical institutes and vocational institutes). Courses last 5 years. At the end of the upper secondary school education, students receive a Diploma that gives them access to higher education. o Regional vocational training system (IFP) offers courses lasting three or four years organised by training agencies. At the end of either a three-year or a four-year regional course, learners receive a qualification that gives them access to second-level regional vocational courses. After a four-year course, learners willing to enroll in a Higher technical institute (ITS) at tertiary level, must attend an additional one-year course in the Higher technical education and training system (IFTS) (post-secondary non-tertiary education).

 Higher education The following institutions offer education at higher level: o Universities (polytechnics included)

o Higher schools for language mediators (Scuole superiori per mediatori linguistici - SSML)

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o High level arts, music and dance education institutes (Alta formazione artistica, musicale e coreutica - Afam)

o Higher technical institutes (Istituti tecnici superiosi - ITS)

- ITSs organise short-cycle programmes according to the Bologna structure.

Access to university, Afam and SSML programmes is solely for students with an upper secondary school leaving certificate. The Ministry of education and individual institutions establish the specific conditions for admission. Courses at ITSs is accessible to students with an upper secondary leaving certificate and to students who have attended regional vocational courses followed by an additional one-year course in the Higher technical education and training system (IFTS).

 Adult educationincludes all activities aiming at cultural enrichment, requalification and professional mobility. Within the broader term ‘adult education’, the domain “School education for adults” (istruzione degli adulti) only refers to the educational activities aimed at the acquisition of a qualification and to literacy and Italian language courses. Adult education is provided by: o Centres for school education for adults (Centri provinciali per l’istruzione degli adulti - CPIA)and o Upper secondary schools.

4.14.2 Public Health Education and Educational Institutions

Studies in the field of Public Health in Italy:

Master:

 Physical Activity and Health Promotion o At Tor Vergata University of Rome o Programme duration: 2 years

 Science and Technology for Population Health and Wealth

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o At University of Brescia o Programme duration: 2 years

 M.A. Occupational Safety and Health o At Turin School of Development o Programme duration: 2 years

 Msc Biology, Curriculum Biodiversity and Enviromental Health

o At University of Siena o Programme duration: 2 years PhD:

 PhD in Infectious Diseases, Microbiology and Public Health Sciences o At Sapienza University of Rome

 PhD in Health Sciences specializing in Public Health o At Universita defli Studi di Milano

 PhD in Applied Life and Health Sciences (thematic research: Genomics, Epidemiology - Bio Statistics and Microbiology – Infectious diseases)

o At University of Verona

4.14.3 Expenditure and Economics in Public Health

In Italy, public financing accounted for 78.2% of total health spending in 2012, while 21.8% was privately financed, through OOP payments (17.8%), especially for pharmaceuticals, outpatient care and dental services, voluntary health insurance (VHI) coverage (0.9%) and non-profit institutions serving households (3.1%). Since the early 2000s the health-care system has been undergoing a process of fiscal devolution from the central government to the regions. Within Italy there are substantial differences in funding between regions, with per capita expenditure ranging from 10.2% below the national average to 17.7% above. Although most funding is pooled at national

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

level and redistributed to regions, there is scope for significant regional variation in tax rates (in particular through taxing corporations and a regional surcharge on income tax). The resulting financing system has an unevenly distributed tax base, smaller room for manoeuvre for poorer regions and a need for poorer regions to increase tax rates more than high-income regions, with consequent disincentives.

As we mention before, the main institution responsible for public health at the national level is the Ministry of Health, which undertakes a stewardship role and sets the general policies targeting health improvement and prevention. Public health policies are implemented by the regions through their Departments of Health and ASLs, the remits of which include protection of the population’s health, health promotion, preventing diseases and disability, and improving quality of life. The main areas of activity are: public hygiene, occupational health, food and nutrition and veterinary health care. In Italy public health expenditure in 2008 amounted to 106.65 billion euros, or 6.8% of GDP (Ministry of Health 2011). On the other hand, an increasingly aging population is creating and will continue to create a growing demand for services both quantitatively and qualitatively. Currently, health expenditure for the over 75s is 11 times higher than that for those aged between 25 and 34. Over the last 15 years, there have been attempts to reorganize the delivery of primary care, with the objective of moving from the traditional model of GPs and other health professionals working in single practices to an integrated care model that connects different health-care professionals and bridges the gap between frontline staff and patients, thoughchange has been slow.

Furthermore, health-care delivery to vulnerable or excluded groups has undergone a recent change in policy. After several years without specific regulations, legislation has now been defined to guarantee that immigrants (both legal and temporarily undocumented) are eligible to receive the same public health-care services that are available to Italian citizens.

The 2012 ‘Spending Review’ (Decree Law n. 95/2012), the ‘Stability Law’ (Legge di Stabilità, Law n. 228/2012) and the ‘Decreto Salva Italia’ (Decree Law n. 201/2011) reduced total public health financing by €900 million in 2012, €1.8 billion in 2013 and a further €2 billion in 2014. This reduction in central funding was compensated for primarily by higher co-payments and cost-saving measures to reduce pharmaceutical expenditures.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Cost-containment measures also targeted the expenditure side: the government decreased outsourcing expenditures to accredited private providers by 0.5% in 2012, 1% in 2013 and 2% in 2014 (compared to the 2011 level). The budget for regions’ pharmaceutical spending, introduced in the late 1990s to force regions to implement effective cost- containment initiatives was also revised, reducing the budget cap that is in place by 0.2% from 13.3% in 2011 to 13.1% in 2012 and 11.35% in 2013 on drugs used in non-hospital settings (patient co-payments are excluded from the budget cap). Moreover, for 2012 the government imposed a 5% reduction in the value of purchasing contracts for medical goods and services signed by public health organizations(including medical devices but excluding pharmaceuticals). The measure places great emphasis on homogenizing the prices of medical goods and services across the country.

Finally, a main feature of the health-care system is regional variation in the distribution of health-care expenditure and in the supply and utilization of services. Public health-care expenditure tends to be lower in less affluent and less economically developed regions, and in Italy such regional differences have persisted despite allocation formulas aimed at equalizing the distribution of financial resources. Nevertheless, these differences are getting smaller.

4.14.4 Challenges and Future Perspectives

The Italian health-care system provides free access to primary care, specialized care and a variety of other public health and preventive services. However, Italy is undergoing an economic and financial crisis, which requires cost containment and resources reallocation policies. These measures are expected to have a marked impact on health care in the years to come, possibly generating inequalities in access to care, sharpening existing differences in the quality of care among regions and affecting the most vulnerable groups of the population. The last five years the economic crisis has worsened some health outcome indicators and increased demand for a variety of services. With some very specific exceptions (e.g. lower number of traffic and work injuries), the crisis has generated a double burden for the health-care system: it has increased demand for health care and at the same time has reduced available resources due to fiscal constraints. Given current financial constraints, waiting times are on the rise and continuity of care and intermediate care for chronic diseases is increasingly difficult to ensure. Efficiency improvements are always possible, however, it is unlikely that further cuts can be made without reducing the quantity and quality of care provided to patients. | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

As we mention, the main institution responsible for public health at the national level is the Ministry of Health, which undertakes a stewardship role and sets the general policies targeting health improvement and prevention. Public health policies are implemented by the regions through their Departments of Health and ASLs, the remits of which include protection of the population’s health, health promotion, preventing diseases and disability, and improving quality of life.

The Ministry of Health of Italy materialize various actions. More spefic:

 Communicable diseases control programmes: vaccinations The Ministry of Health estimates that the National Health Service will need to invest €100 million in 2017, €127 million in 2018 and €186 million in 2019 mostly related to purchasing the vaccines. The routine immunization programme includes diphtheria, tetanus (DT) and poliovirus (oral poliovirus vaccine – OPV) vaccinations, which have been mandatory by law since the early 1960s for all newborns under 24 months. The hepatitis B vaccine was added in 1991, introducing universal vaccination of infants and children (up to 12 years of age). Vaccinations against pertussis, measles, mumps, rubella, Haemophilus influenzae type b (Hib), meningococcal C and pneumococcal meningitis, chickenpox and human papillomavirus (HPV) are non-mandatory vaccinations but are recommended by the Ministry of Health. Compulsory and recommended vaccinations are included in the benefit package and are provided free of charge for all Italian and foreign children living in the country.  Occupational health Driven by EC Directives, the occupational health sector has made significant progress in recent years. The Italian Occupational Health and Safety Act (Legislative Decree 81/2008) provides the legal framework, setting out the rights and duties of all parties in the workplace and harmonizing previous legislation. Today, in all workplaces where workers can be exposed to specific risks an occupational health specialist must be appointed by law for medical check-ups of employees and education information activities.

 Screening programmes

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Since 2001, the government has adopted a series of measures to promote the widespread and uniform adoption of screening policies and guiding principles at the national level. Secondary cancer prevention has been included in the benefit package. To improve screening coverage and following the EU’s recommendation on cancer screening (December 2003), several plans have been developed with the aim of strengthening the diffusion of active programmes: National Health Plan (2003–2005), National Screening Plans (2004–2006 and 2007–2009) and National Prevention Plan (2005–2007). Cervical pap tests, mammography and colorectal screening are offered free of charge to target populations nationally. For cervical cancer the pap test is offered every three years to women aged 25–64, in accordance with EU guidelines. Mammography screening is offered every two years to women aged 50–69. As for colorectal screening, current guidelines recommend two screening tests: the majority of programmes use the faecal occult blood (FOB) test in populations aged 50–69/74, while others (mainly those in the Piedmont and Veneto regions) have adopted flexible sigmoidoscopy (FS) once in a lifetime (or with a frequency of at least 10 years) in patients aged 58 or 60. The screening programmes are regulated and organized at the regional level through the ASLs, which actively invite the target population to have preventive tests (mammography, pap test, FOB test) free of charge. Participation in screening programmes is voluntary and several indicators are calculated to monitor screening invitations and uptake, which impacts on the efficacy of programmes in reducing cancer mortality. Smoking bans It is worth mentioning that, as a major national public health measure to reduce the prevalence of tobacco usage, the introduction of a general ban of smoking in all public and working places was implemented in 2012. This ban was implemented rapidly. Conclusionaly, Immunization and screening programmes are considered to be priorities. In addition to the mandatory and voluntary routine immunization programmes, pap tests, mammography and colorectal screening are offered free of charge to target populations nationally. 4.15 Latvia

According to the Education Law (1998); last amended in January 2007), the National Education Standards provide the strategic goals and main tasks of compulsory curricula, syllabus, basic principles and procedure for the assessment of education acquired by a pupil. The long-range conceptual framework document approved by the Parliament in 2005: „The Latvian Growth Model: People Take First Place” proscribes a person-centered

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

model for growth in Latvia. An educated and knowledge-based society becomes the key to internal and external national security. Thus the main goals of the Latvian education and training system are to support the building of a knowledge-based, democratic and socially integrated society, in order to increase competitiveness of the Latvian population and economy, and simultaneously preserve and develop cultural values typical for Latviaed in tertiary education in Latvia.

Pre-school and early childhood care have important role in educational system of Latvia. While pre-primary education was optional until the 2001/2002 school year, it became mandatory in 2002 for five- and six-year-old children. The objective of pre-school education is to foster the overall development of children and to prepare them to enter the primary stage of basic general education. It is considered the first stage of general education and all children should complete it by the age of 7. Basic (Primary and Lower Secondary) and Upper Secondary Education are obliged by law and children are obliged to attend school from the year when they turn seven till the age of 16. After finishing basic education, most young people continue their education at upper secondary level in general upper secondary school, while about a fourth attends technical and further education schools. The compulsory curriculum of 3-year general upper secondary schools is determined by the National Standard in the four standardized educational profiles: (1) comprehensive education, without intensive teaching of any particular subject and (2) the humanities and social sciences program; (3) the mathematics, natural science and technical science program; (4) the vocational program, where the general education curriculum places emphasis on subjects in these particular fields. Educational standards and Regulations regarding assessment of learning achievement for the compulsory school and general upper secondary school are drafted by the Centre for Curriculum Development and Examination which is a national administrative body reporting directly to the Minister of Education and Science, and are approved by the Cabinet of Ministers. Children may attend vocation-oriented education in arts and music or another area of personal interest in addition to attending regular school which are generally founded and maintained by municipal governments. This type of education is voluntary and provides for a person’s individual educational needs and wishes. This education does not lead to a professional qualification. Special education schools or special education classes within general education schools provide education for children with special needs that correspond to each individual’s physical and mental condition. The structure of special education is very similar to that of the mainstream education, providing opportunities for persons with special needs to attain

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

general knowledge and skills with a strong emphasis on their applicability, thus facilitating social inclusion. There are 64 special education schools in Latvia.

Vocational and Further Education has also important role in Latvian education system. The majority of vocational schools in Latvia provide 2-3 and 4-year vocational education and training programs at upper secondary level, and only some programs are designed for basic vocational and training purposes. The National Standard of Vocational Education and the Occupational Standards determine the curriculum content of vocational education programs. Practical training on-the-job comprises at least 20-25% of studies while the theoretical part provides the knowledge needed in modern society: a command of languages, mathematics, natural sciences and social studies, and good communication skills. In addition, vocational training also underlines the following skills: entrepreneurship, global environmental awareness, internationalization and citizenship. Sample curricula are drawn up by the Vocational Education Administration, an institution under the authority of the Ministry of Educationand Science. Both Occupational Standards and sample curricula are developed in cooperation with professional associations representing different economic sectors. Based on the relevant standards and sample programs, schools develop their own training programs in accordance with the needs of the local labur market.

Basic vocational and training programs are intended to provide training in simple trades for pupils who have not finished compulsory nine-year basic education by the age of 16. By successfully completing this educational program, the pupil obtains a basic education certificate and may go on to upper secondary education. The number of students enrolled in these programs is not large, from 2% to 2.3% of the total. Vocational education programs lasting two or three years provide theoretical and practical knowledge required for a skilled worker. On completing such program, the student has not obtained a full upper secondary education. For this, an additional year of schooling is required. The proportion of students enrolled in these vocational programs is approximately 18% of the total. Upper secondary vocational education programs which last four years provide much wider theoretical knowledge and practical skills. This is a full secondary education program, so the school-leaver is entitled to enter higher education. Approximately 70% of students in vocational education choose upper-secondary programs.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Latvia has two sorts of higher education programs – academic and professional. Professional higher education is divided into two levels. First level professional higher education programs lasting 2-3 years after upper secondary education are provided by Colleges. Second level professional higher education programs last at least four years after upper secondary education or two years after acquiring Bachelor’s degree (3-year studies). These programs, as well as higher academic education programs are offered at universities or non-university-type higher education institutions. The right to enter a higher education institution is held by all those who have completed general upper secondary education or graduated from a four-year vocational program. In Latvia, there are both state-financed and private higher education institutions. In 2007 of 60 accredited higher education institutions, 34 were university/non-university type institutions (19 of them government- funded and the rest founded by other legal entities or private individuals) and 26 colleges (18 state and 8 private). In Latvia there are 568 students per 10,000 inhabitants, which is the second largest proportion in the world. Foreign students comprised from 1% to 3% of total enrolment and programs for foreign students are mainly realized in English or in Russian.

As it is already said, The Law on Institutions of Higher Education makes distinction between university-type and non-university-type institutions. While non-university-type institutions run professional programs, universities often offer both academic and professional programs. The law defines four determinant criteria for a university status: implementation ofbachelor, master and doctor study programs; assertion of doctoral thesis occurs annually, at least half of persons elected in academic posts hold a doctor’s degree, institution issues scientific publications and establishes scientific institutions or units in the main scientific disciplines corresponding to the implemented studyprograms.On the other side, colleges may function under higher educational institution and also as an independent institution. Colleges provide first-level higher professional education considered as the first phase of the second-level professional higher education programs offered by a higher education institution.

First Cycle Programs- Higher academic educationprograms last for three or four years for Bachelor degree. The Cabinet of Ministers issues Regulations regarding the State Standard for Academic Education. Professional higher education is divided into first and second-level professional higher education- First-level professional higher educationprograms which are short-cycle programs or college programs mainly aimed at preparing specialists forthe labor marketand last two or three years while second level professional higher education programslead to professional Bachelor's degree. These programs encompassing first-level

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

studies last at least four years. The amount of full-time and part-time Bachelor study programs is from 120 to 160 credit points including at least 10 credit points for Bachelor thesis. Professional higher education Bachelor study programs (second-level professional higher education programs) last at least 160 credit points. The structure of study programs consists of study courses, internship outside educational institution and state examinations including development and defense of Bachelor or Diploma thesis. At least 30% of study courses should be practically taught. According to thematic groups of education determined in the Regulations on Classification of Education in Latvia and the Law on Institutions of Higher Education, education programs are available in the following study fields: Education, Humanities and Arts, Social Sciences, Business and Law Natural Sciences, Mathematics and IT, Engineering, Production and Construction, Agriculture, Health and Welfare, Services.

Academic Bachelor degree allows continuing studies in the same or a related branch of science in Master program. A state-recognized diploma is issued to persons who have completed accredited study programs. Only accredited higher education institutions providing state-accredited study programs have the right to issue state-recognized diplomas. Diploma Supplement is issued to each graduate (except those of doctoral programs) and it covers information regarding the nature, level, context and status of the pursued and completed studies. Students of second-level professional higher education programs also pass final examinations at the end of studies and receive a diploma certifying the Professional Bachelor degree and fifth-level professional qualification (after professional higher education Bachelor study programs) or fifth-level professional qualification (after professional higher education study programs). The Diploma Supplement is also issued.

Short-Cycle Higher Education-The Vocational Education Law (1999) stipulates professional higher education at two levels and first are first level higher professional education programs or college programs (ISCED 5B level or professional qualification level 4 according to the Regulations on Classification of Education in Latvia).First level higher professional education programs (2-3 years after upper-secondary education) are available at college. The Diploma of the first level higher professional education is equal to professional qualification level 4, i.e. occupations of complex level are mastered, for example, bank officers, lawyer assistants, technologists. This qualification allows working in the occupation or continuing studies in the relevant higher education program.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

The Cabinet of Ministers issues the Regulations regarding the State Standard for the First Level Higher Professional Education. The content of first level higher professional education comprises study courses (comprising general subjects, humanities, social sciences as well as technical subjects), a practical placement and a thesis. The content of the study course and the practical placement is set out in occupational standards for some professions. The volume of programs in credit points is 80-120.

Second Cycle Programs are available in the following study fields:Education, Humanities and Arts, Social Sciences, Business and Law, Natural Sciences, Mathematics and IT, Engineering, Production and Construction, Agriculture, Health and Welfare, Services. These programs last one ortwo years. Only candidates with Bachelor degree or at least four-year studies leading to professional qualification are eligible to second-level professional higher education programs offered as Master or Professional (higher level of studies after an academic degree) programs.

The academic master study programs have 80 credit points including at least 20 credit points for Master thesis. The compulsory content of Master programs includes research on theoretical conclusions (at least 30 credit points) of the respective area in the field or sub- field of science and approbation of theoretical conclusions (at least 15 credit points) currently important in the field or sub field of science. The professional higher education master study programs (second-level professional higher education program) have at least 40 credit points. Study courses include approbation of recent accomplishments in theory and practice of the study field, courses on management, research work, pedagogy and psychology. Internship and state examinations involving the development and defense of Master or Diploma thesis are also a part of compulsory study content. Students pass final examinations at the end of academic Master study programs.

Only university-type institution may run doctoral programs. The doctoral programs are offered in the following fields: Social Sciences and Law, Humanities and Arts, Natural Sciences Technical Sciences Medicine. Doctoral study activities last three or four years for Doctoral scientific degree. The doctoral programs have is 120-160 credit points (of which 40-60 credit points are awarded for teaching a certain number of courses). Doctoral study programs contain also the list of compulsory and optional subjects and corresponding number of credit points. The rest of the content of doctoral studies includes independent research with the aim to obtain original and verified results in the corresponding branch.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Adult and non-formal education has a very important role in higher education system of Montenegro. Adult education in Latvia is supported by the principle of lifelong education. Different types of further education and training are offered to persons after graduating from general upper secondary or 2-3 year vocational education and training programs. These programs are focused on mastering professional skills and knowledge in line with the requirements of the respective qualification level. The training process and assessment of achievements are organized in a similar manner as in vocational secondary education and training programs. Labor market training for the unemployed accounts for the largest number of participants in the adult education sector. Employment authorities provide a wide range of labor market training mainly targeted at unemployed adults. The courses are free of charge to persons who qualify for official unemployment status. Adults can also follow a complete program of basic education or upper secondary education at so-called evening schools. Leading legislation regulating the general area of education is: Law on Education (1998), Law on General Education (1999), Law on Vocational Education (1999), Law on Higher Education Establishments (1995) and Law on Scientific Activity (2005). Ministry of Education and Science is in charge of implementation of all these law. It is involved in the decision-making process and it oversees all the educational institutions in the country.

The educational system is administered on three levels – national, municipal and institutional. The Parliament, Cabinet of Ministers and Ministry of Education and Science are the main decision-making bodies on the national level. The Ministry as the leading public administration institution in the field of education and science implements a single national policy and development strategy in education, develops education, science, sport, youth and state language policies, organizes and coordinates their implementation, as well as develops draft regulatory legislation regulating the sector, and develops draft policy planning documents. Every municipality supervises the pre-school, basic and general upper secondary schools located in its administrative territory and participates in funding the maintenance expenses of those educational institutions. A Board of Education is established by each municipality to perform its education-related functions. Vocational education and training schools are mainly maintained and supervised by the Ministry of Education and Science. Only art and music schools are placed under the authority of the Ministry of Culture. Private and municipal schools must be registered with the National Registrar of Education and comply with government education standards. In the tertiary sector, decision-making, regulation, funding and governance are shared between the government and the institutions themselves. Higher education institutions are autonomous

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

bodies established under national legislation, each with their own independent governing body (senate). The primary institution responsible for higher education is the Ministry of Education and Science which administers government funding, policy and programs. While higher education institutions are autonomous, they are accountable to the government via accreditation.

Public primary and secondary general education in Latvia is free of charge and is financed from the municipal budget. At primary and secondary schools, the state pays teachers' wages, while the local authority finances the maintenance of the school building and grounds and covers other expenses connected with teaching. Vocational schools in Latvia usually belong to the state or the local authority, which accordingly finances both teaching and maintenance of the school. Private educational establishments at primary-secondary level may set their own tuition fees. Accredited private lower and upper secondary schools receive a subsidy from the national government budget to cover teachers’ salaries and related social security taxes in order to fund the provision of accredited lower and upper secondary education programs. Accredited private vocational education schools receive a national government subsidy based on a training agreement between a government ministry and the training institution for the training of a determined number of persons in a specific vocational area. There are between 20% and 30% of students funded by the state budget every year. Those students who pass their entrance examinations at state higher education institutions, but whose marks are not sufficiently high to grant them state- supported education, can take up studies as fee-paying students. Similarly, fees are charged at all private higher education institutions. Adult education can be financed from the government or local government budget, employers’ resources, learners’ resources, donations and grants, as well as from other sources. There are different institutions on national and local levels involved in organization and provision of adult education. The tuition fees for continuing or in-service education and training are established by training providers and covered by individuals or employers. Further training or retraining of persons who are legally classified as unemployed is financed from the state budget.

The Laws on Education, General Education, Vocational Education and Higher Education proscribe the monitoring and assessment of each respective sub-sector of the education system by relevant national and local government authorities. Every education institution, regardless whether it is founded by national or local government or private concerns, must be registered with the National Registrar of Education. In order to begin providing education services, a license must be obtained. The right to deliver nationally recognized diplomas and certificates is only conferred on education institutions accredited by the

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

respective national institutions (the State Agency for Quality Assessment in General Education, the Vocational Education Administration and the Higher Education Quality Evaluation Centre). Although there are initial steps, e-learning is still far away from being implemented. It is the same case with lifelong learning, it is stipulated in strategic documents but not implemented to the same extent.8 Public Health Strategy of Latvia for 2011-2017 recognizes connection with the Guidelines on Education Development for 2007-2013 and necessity of lifelong learning.9 Public Health study programs are organized on Medical Academy of Latvia and The Faculty of Public Health and Social Welfare of Rīga Stradiņš Universityon bachelor and master level of studies. Those are state funded universities, while the first one is the only university in Latvia which is integrated in the healthcare system of Latvia and Ministry of Health has responsibility for education at this university. Upon the finished studies, in order to become a practitioner, one has to enter the Latvian Medical Association and have to be entered into the Register of Medical Persons.

Bachelor studieson public health are organized on Medical Academy of Latvia. Medical academy of Latvia consists of seven faculties. These are: Faculty of medicine, Faculty of dentistry, Faculty of Pharmacy, Faculty of rehabilitation, Faculty of Nursing, Faculty of public Health, Faculty of Social Sciences,

Bachelor of public health is provided after the completition of a Public health study program as well as Diploma of Bachelor of Public Health Diploma of Specialist in Environment Health Diploma of Specialist in Health Promotion Diploma of Health Care Manager. The programs last for 4 years- 8 semesters. The curriculum comprises biomedical sciences and the Humanities, basic courses of medical and special disciplines of health sciences. During the studies the students acquire theoretical knowledge in Anatomy, Biology, Biochemistry, Physiology as well as knowledge on development and prophylactics of different pathological conditions and diseases. Subjects like philosophy, ethics, psychology, sociology, pedagogy and legislation are offered. The course in Environment health includes topics on environment, its negative impact to organism, environment evaluation and possible improvement. The course in

8http://www.ibe.unesco.org/National_Reports/ICE_2008/latvia_NR08.pdf 9http://www.who.int/fctc/reporting/party_reports/latvia_annex2_public_health_strategy_2011_2017.pdf | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Public Health includes main health problems in the world and in Latvia, epidemiological methods for its analysis, health policy, management and financing of health care. Students acquire skills in analysis and interpretation of statistical data. The Faculty of Public Health and Social Welfare of Rīga Stradiņš University also offers publis health study programs. The Faculty itself was established on 20 May 2014 on the grounds of the decision taken by RSU Senate by merging the Faculty of Nursing, the Faculty of Public Health, the Department of Social Work of the Faculty of Rehabilitation and the Department of Sports, Nutrition and Pedagogy. By the decision of RSU Senate of 28 June 2016, RSU Liepāja Branch was subordinated to the Faculty of Public Health and Social Welfare. The faculty includes five departments, which represent the following major areas of study:

 Public Health and Epidemiology, which enables students to gain knowledge and skills for effective practice in public health care organisations and institutions by applying latest scientific achievements to the solution of not only current public health problems, but ones that may affect our society in the future as well.

 Nursing and Midwifery, which ensures a comprehensive training to become a qualified nurse or midwife, who would be skilled and able to provide patients and their family members with the latest health care practices. This includes organising, coordinating and leading patient care at all health care levels. Additional emphasis is put on developing critical thinking skills through research.

 Sports and Nutrition assists students to gain a deeper understanding of the importance of a healthy lifestyle. Throughout the studies students gain an appreciation of the benefits of a healthy diet and workout. As a medical university, we put particular emphasis on the importance of proper workout and diet for healthy individuals as well as those who have decided to change their lifestyle due to a serious illness.

 Health Psychology and Pedagogy, which places an emphasis on the importance of psychology and pedagogy, when trying to facilitate a healthy lifestyle of a patient as well as their emotional and social wellbeing. Students are encouraged to understand the regularities between pedagogy and life opportunities as well as their emotional wellbeing and various illnesses. Throughout the studies students learn how to help patients resolve the emotional causes of diseases

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

with the help of GPs and other experts, thus reducing their impact on the patient’s quality of life.

 Welfare and Social Work provides students with a comprehensive training in social welfare practices both when working with grown-ups or children and young people in a variety of organisational settings – from governmental to nongovernmental institutions and agencies. Students are encouraged to explore the latest research to understand how to help those in need of social services. Covered topics include youth work, human rights, social planning and social work. Faculty of Public Health and Social Welfare offers several programs: These are Health Sport Specialist, Nursing (undergraduate), Midwifery (undergraduate), Social Work (undergraduate), Nursing (master), Social Work (master), Public Health (master), Nutrition Science (master), Health Psychology (master), Supervision (master) and Social Work with Children and Youth (master).

The aim of the undergraduate program Public Health is to provide education for students seeking to become highly qualified professionals in the field of public health who possess theoretical knowledge and practical skills and are able to identify problems in the field of public health, make evidence-based decisions, participate in the development, evaluation and implementation of various public health-related programs. The program last for 8 semesters- 4 years and degree awarded is Professional Bachelor’s degree of Health Care. The program is provided in Latvian language.

The master study program in Public Health last for 4 semesters- 2 years and master's degree of health sciences in health care is provided. Degree provided is Master’s degree of Health Science in Health Care (MSc). The program is realized in English. The aim of the program is to prepare highly skilled specialists for the scientific research in the field of public health (epidemiology, environmental health, health promotion, health care organization and health statistics) with fundamental theoretical knowledge in public health and research methodology and practical skills of public health research. Master's study program has been worked out considering the recommendations of the Association of European Public Health Schools (ASPHER). Compulsory courses on the first year are:

 Public Health Theory

 Research Methods

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Epidemiology

 Qualitative Research Methods

 Statistics

During the second year of the study, student work on master thesis and choose five elective courses which are usually:

 Patient Rights

 Professional Ethics

 Business Protocol and Presentation Skills

 Health Management

 Health Promotion Policy

 Psychosocial Problems in the Workplace Main objectives of the study program are:

 to provide students with opportunities to acquire in-depth theoretical knowledge in public health and research methodology;

 to promote skills and competences necessary for research data collection, processing and analysis;

 to develop the ability to link together theoretical knowledge and research findings in public health practice;

 to promote the use of evidence-based decisions in public health practice;

 to provide an opportunity for acquisition of additional knowledge in elective study courses because of need to form a multi-disciplinary approach to specific public health problems;

 to increase students participation in research (projects, conferences, publication);

 to provide the ability of graduates to compete in the European labor market.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

It is also interesting to mention one interesting master program that is realized on the same University and that is master program in Health Management which is the only program of the kind in the Baltics. It gives opportunity to obtain theoretical and practical knowledge in health management field based on European and international approach to health system management and applicable in real work. This study program is module- based, and part of the teaching staff is invited from foreign Universities. The program is jointly implemented by Riga Stradiņš University (RSU) and Riga International School of Economics and Business Administration. Degree awarded is master in health management. The program has been designed to

 to develop economic and management knowledge, which are necessary for effective management of organizations and enterprises in health care sector

 to prepare high level specialists for professional work of a manager in health sector

 to support implementation of practical development and change projects in organizations and enterprises in health sector

The program offers courses:

 Introductory Course: Basics of Economics (for students without economic or management knowledge, at extra cost)

 Module 1: Fundamentals Public Health and Health Economics

 Module 2: Fundamentals of Management in HC

 Module 3: Health system design

 Module 4: Leadership and Finance in HC

 Module 5: Health system and performance Management

 Module 6: HCO Marketing and Project Management

 Module 7: Research projects and internship

 Final Module and Master Thesis

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.16 Lithuania

In Lithuania education is free of charge and compulsory from the age of 6 or 7 to 16 years (covering "primary" and "basic" education), as stated in the national Law of Education. Pre- tertiary education is organized in 4 main cycles: Pre-school education (until age 5 or 6), pre- primary education which lasts for one year (between age 5-7), primary education which lasts for four years (between age 6-11), basic education which last for six years (between age 10-17 and ends on a "basic education certificate"). Upper secondary education lasts for two years (between age 16-19) and ends on the "matura" examination which opens gates to tertiary education. Vocational and technical education starts at the fifth year of basic education (age 14-15)- it lasts two to three years before the "basic education certificate". Students can then pursue into vocational upper secondary education, which also leads, after two or three years, to a "matura" examination.However, in order to reach tertiary education (university or college), vocational students have to follow an extra "post- secondary" education program of 2 years. Regarding to tertiary or higher education it is important to point out that Lithuania has implemented the Bologna process in 2006. Higher education qualifications can only be acquired at higher education institutions. Non-university-level studies are organized in one- cycle undergraduate studies. University-level studies are organized in three cycles: first cycle (undergraduate); second cycle (graduate); and third cycle (post-graduate).University undergraduate studies last from 4 to 5.5 years (140 to 180 national credits). To be admitted, students should hold a Maturity Certificate or a comparable qualification. Undergraduate programs comply to the guidelines approved by the Ministry of Education and Science. They establish all the general requirements of a program including the basic qualification requirements for the academic and professional staff. The first cycle leads to the Bachelor degree and/or a professional qualification. Master's Degrees last for one-and-a- half to two years (60-80 national credits). To be admitted, students should hold a qualification obtained after completion of a university first cycle study program or a comparable qualification. The general requirements for Master programs are approved by the Ministry of Education and Science. Studies lead to a Master degree and /or a professional qualification. The Higher Education Diploma is awarded when studies lead to a professional qualification. These qualifications generally give the right to enter university third cycle studies. Special professional studies last for 1 to 2 years (40 to 80 national credits). To be admitted, students should hold a university first cycle or a comparable qualification. These studies prepare for activities requiring special practical abilities. The general requirements for special professional programs are approved by the Ministry of

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Education and Science. These studies lead to a professional qualification. After completion of studies, a Higher Education Diploma is awarded. Generally, a qualification obtained after this type of studies does not give the right to enter third cycle university (postgraduate) studies. There are also integrated studies that combine university first and second cycles. To be admitted, students should hold a Maturity Certificate or a comparable qualification. Studies lead to a Master degree or a professional qualification. When studies lead to the award of a professional qualification, they last for at least 4.5 but not more than 6 years (180 to 240 national credits). When studies lead to the award of a Master's degree, they last for at least 5 but not more than 6 years (200 to 240 national credits). The only exceptions in integrated studies are made in the fields of Medicine, Odontology and Veterinary Medicine where studies may last longer but no more than 7 years (a maximum of 280 national credits). On completion of integrated studies a Higher Education Diploma is awarded. Generally, a qualification obtained after completion of integrated studies gives the right to enter university third cycle. University postgraduate (third cycle) studies are also called residency studies and last from 2 to 6 years (80 to 240 national credits). They are designed exclusively for the training of specialists in the fields of Medicine, Odontology and Veterinary Medicine. To be admitted, students should hold an integrated study qualification, namely: Doctor; Medical Doctor; Doctor Odontologist; Veterinary Surgeon or a comparable qualification. On completion of studies, a Residency certificate in a special field is awarded. Postgraduate art studies last for a maximum of two years (up to 80 national credits). They are designed to train higher education institution art teachers and specialized artists. To be admitted, students should hold a Master's degree awarded on completion of university second cycle studies or a comparable qualification in the area of arts. After the successful completion of the studies, the postgraduate Licentiate diploma in Art Studies is awarded. Doctoral studies last for 3 to 4 years. Studies consist of doctoral courses (at least 20 national credits), specific research activities and the preparation of a doctoral dissertation. Doctoral studies are jointly organized by higher education and research institutions. Upon completion of the doctoral course, a doctoral thesis must be prepared and publicly defended in order for the candidate to qualify for the Doctorate. To be admitted, students should hold a Master's degree or a comparable qualification. After the defense of the doctoral thesis, the degree of Doctor is awarded. The quality of the programs as well as the educational and scientific activities of higher education institutions are periodically assessed by the Centre for Quality Assessment in Higher Education. The national credit system is based on an average of 1600 working hours per academic year, one credit corresponding to 40 hours or one week of work. There are three modes of study: daytime, evening and extra-mural.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

There are two main laws: Law on Higher Education from 2009 and Law on Education from 2011. In addition to this, available Strategy for Education relates to the period until 2012.

It is interesting to mention the Lithuanian financing system in education. Education of pupils in general education schools is financed through a state budget target grant under the principle of the pupil’s voucher. Every year, the state allocates, by taking into account the number of pupils, a special target grant to municipalities. The pupil’s voucher is allocated both for public and private schools. When moving to another school, a pupil takes his voucher with him. The pupil‘s voucher includes money for teachers‘ salaries, improvement of teachers‘ skills, textbooks, instructional aids, special psychological aid, cognitive activities of pupils, professional guidance, modules of professional artistic education programs, administration, execution, assessment of maturity examinations, etc. Utility expenses of private schools are covered by their stakeholders. Funds for schools of traditional religious communities are allocated by the state under the Agreement between the Republic of Lithuania and the Holy See. Regarding to higher education, dovernment defined total number of students financed by state per number of fields of studies. Initially (2009) it was 6 fields: social sciences, humanities, arts, biomedical sciences, physical sciences and mathematics; technological sciences. State finance is granted only for best graduates of secondary school, but it is evedently that number of granted students is decresing.

12000 11019 9680 9680 10000 8975 7581 8000

6000

4000

2000 0 2009 2010 2011 2012 2013

Diagram 4.17.1. State finance places of universities in Lithuania Source: Ministry of Education and Science, 2013.

Average tuition fees in higher education institutions depend on the field of study and the study cycle.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Table 4.17.1. Study price (in €) per field of study, 2014.

Source: Ministry of Education and Science, 2013 Scholarships are offered by the state, higher education institutions and International Scholarship Programs. Each higher education institution also has its own scholarship funds and financing schemes based on which one-time awards or other type of awards are given to the students meeting certain requirements from institution’s funds.

E-learning is still underdeveloped and is not recognized by available strategy. In the future Lithuania is aiming to focus funds and attention to non-formal means of education.10 It has already have relatively stable and low number of drop outs: EU goals are that it is below 10%, Lithuanian target is below 9% and real number is 5,5%. When it comes to third level education, EU standards are that at least 40% of 30-34 year olds complete third level education by 2020. Lithuanian target is 48,7%, while the real number is currently 56,4%.

10http://ec.europa.eu/europe2020/pdf/csr2016/nrp2016_lithuania_en.pdf | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Regarding to Non-formal education it is important to mention that after classes, pupils can choose various leisure activities provided in schools free of charge or attend separate sports, music, fine arts, art, aviation, and choreography schools, and children’s clubs. The latter activities are partially paid; professional artists, sportsmen, and teachers work with children. In schools, pupils can be excused from attending weekly classes in Arts and Physical Training, if they have graduated from schools of art or study Fine Arts, Choreography, or Music in schools of art or non-formal education establishments specializing in sports. The long-term artistic education program completed in children’s music, art, and sports schools or any other school can be recognized as a vocational education module. Special education is provided in pre-school education establishments and general education schools of all types. If needed, general education programs can be adapted taking into account pupil’s special education needs. Free assistance of special pedagogues, speech therapists, psychologists, and other specialists can be provided to pupils in schools as well as to parents and teachers in other institutions. A child’s need for special education is determined by a municipal pedagogical psychological unit or by a school special education commission. It is important to mention that Vocation Education Training and Life Long Learning are also introduced in Lithuania education system. The vocational education system covers initial and continuing vocational education and training. Initial Vocational Education and Training (IVET) can start at the age 14 (fifth year of Basic education) and usually lasts for two or three years depending on the level of the audience. The duration of studies for students who have already obtained secondary education is 1 to 1.5 years and students can then pursue into vocational upper secondary educatio that usually lasts 2 or 3 years and ends on a "matura" examination. In order to join tertiary education (university or college), vocational students have to follow an extra "post-secondary education" program which last for one or two years. The training program consists of two parts. The first part is common to all schools in the country and defines fields of professional activities, competencies, teaching goals, and assessment provisions. The second part is optional and covers teaching methods, subject programs, teaching aids, etc. The program must include the subjects or modules of Entrepreneurship, Civil Protection, Ecology, Information Technologies, and Foreign Language for Specific Purposes. 60-70 percent of the total time allocated to vocational subjects should be devoted to practical training. Usually, practical training is conducted at the school or in a company. Training can also be performed under exchange programs.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Initial vocational training is financed through the state budget. Vocational training providers receive financing by applying the methodology of the pupil’s voucher, i.e. calculation of teaching funds per pupil. The same principle is applied when allocating utility funds. Most of vocational school pupils receive grants. Continuing education is usually conducted through the funds of companies, institutions, the Employment Fund, other funds, or personal funds of pupils. Requirements for vocational training programs are set out by the General Requirements and Standards for Vocational Training of the Ministry of Education and Science. Continuing Vocational Education and Training targets learners older than 18. It consists of usually short programs (a year or less), mainly dedicated to practical training (60 to 80% of the program). They can lead to a vocational qualification, to an additional vocational qualification, or to a competence to perform jobs or functions regulated by law. Regarding to adult education it is important to mention that once students have reached 18 years of age, they are offered a variety of opportunities for further education. It is possible to continue one’s education in general education schools and centers for adults, by taking various courses or just using the Internet, reading books, or being interested in special literature. They can obtain primary, basic or secondary education in adult schools, education centers, and general education schools with forms established for adults. General education of adults is organized by approx. 60 institutions in all municipalities of the country, which number about 12 thousand adults. These schools also provide non-formal adult education services.The scope and subjects of study programs for adults are adapted according to the needs. Adults who study under general education and non-formal education programs can choose a flexible learning form that is most suitable for them — modular education, independent education, extramural education, or distance education. These forms allow adults choosing suitable time for their studies and a study program, as well as planning their learning process on their own.Part of consultations under the correspondence and individual programs (and all consultations for disabled people) can be provided distantly, by communicating with teachers with the help of information communication technologies — Internet sites, e-mail, or Internet Telephony Programs.Non-formal adult education is organized by approx. 700 public and private institutions. These include 63 state-owned companies, 288 joint-stock companies, 271 individual companies and 46 foreign investment companies. In addition, special departments for adult training have been set up in the universities. Adult learning also takes place in the workplace and is organized by the employers taking into account their business demands.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

A concept of distance higher education is also introduced in Lithuania higher education system. Course programs are conducted by transmitting to the student specially prepared learning materials through the postal services. Various virtual environments were introduced and are developed by universities.

There are 24 colleges (13 of them are public and 11 are private) and 23 universities (14 of them are public, 8 are private, and one is a branch of a Polish university) offer study programs in Lithuania. It is interesting to mention that the population of foreign students keeps rising – in 2015, 12% more students came to study in Lithuania (4652 in total). The majority of foreign students choose the Lithuanian University of Health Sciences. In 2015, as in previous years, medicine was the most popular study program. Other study programs such as engineering, management and social work are also popular among foreign students.

Public health is a life science study program, available at Lithuanian University of Health Science (LSMU), Vilnius University and Klaipėda University.

Public health studies are provided on Lithuanian University of Health Sciences which represents a consolidation of two institutions of higher education, Kaunas University of Medicine and the Lithuanian Veterinary Academy. It is a public university of the Republic of Lithuania. The university includes 7 faculties (Faculty of Medicine, Faculty of Odontology, Faculty of Pharmacy, Faculty of Nursing, Faculty of Public Health, Faculty of Veterinary Medicine and Faculty of Animal Husbandry Technology), 6 research institutes, two animal clinics and the Hospital of LSMU. Today, LSMU is the country’s largest specialized health education institution with 21,000 members and staff, including over 7,000 students, which offers university degrees, training and research in biomedical sciences. The University is a member of numerous international organizations, such as the European University Association (EUA), The Association of Schools of Public Health in the European Region (ASPHER), The Association of Medical Schools in Europe (AMSE), Association for Medical Education in Europe (AMEE), Baltic Sea Region University Network (BSRUN), Organization for PhD Education in Biomedicine and Health Sciences in the European System (ORPHEUS), European Association of Establishments for Veterinary Education (EAEVE), World Veterinary Association, and more. LSMU is also a member of the World Health Organization, where it fulfils the role of a collaboration center for research and training in epidemiology, as well as for the prevention of cardiovascular and other chronic non-communicable diseases.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Faculty of Public Health (FPH) of Lithuanian University of Health Sciences was established in 1994. It is a place where variety of research and training competences meet together, enabling those who work in public health practice and research to effectively confront the challenges of rapidly changing health care system. Public health and health management fields require lifelong learning. The competences in biomedical, social, psychological and multicultural areas that affect health of population are necessary for the modern public health professionals, health managers or health politicians. To meet this challenge, new creative methods of training and research are widely applied in the training programs. Training programs that are offered at the FPH help participants to take a leadership role in public health and health care organizations, as well as other health care institutions. The Faculty consists of five departments and institute of Health Research which is one of the important units fostering public health research activities and taking leading role in both national and international research projects, contributing actively to health policy development in Lithuania. FPH is an active member of the Association of Schools of Public Health in the European Region (ASPHER). The Faculty provides undergraduate, postgraduate and PhD studies. These are:

Table 4.17.2. Faculty of Public Health (FPH) of Lithuanian University of Health Sciences: study programs.

Title of the Length of Language of Level programme studies (years) instructions Public Health Bachelor 4 Lithuanian Social Work in Bachelor 4 Lithuanian Medicine Health Psychology Bachelor 4 Lithuanian Health Informatics Bachelor 4 Lithuanian Public Health Master 2 Lithuanian; English Management of Full time 2; Part Master Lithuanian Public Health time 3 Health Psychology Master 2 Lithuanian

Lifestyle Medicine Master 1,5 Lithuanian, English Doctoral in Public Doctor of 4 Lithuanian Health Sciences

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Lithuanian University of Health Sciences, Faculty of Veterinary Medicine organizes Bachelor studies of Public Health - Food Safety. The program is organized on, lasts for 4 years and has 240 ECTS credits. After the completition of study program students obtain degree Bachelor of Public Health, Food Safety program. The study program is aimed to prepare the professionals devoted to the application of their skills and knowledge for the protection and improvement of public health through ensuring and enhancing food safety along food production chain and by reducing human exposure to chemical and biological hazards arising from the food consumption. Coursework is organized into semesters: students have five to seven subjects every semester. A few compulsory placements must be completed at food-related laboratories, food industry, veterinary services or bodies responsible for safety in the food chain. Examinations are taken upon completion of each subject. The studies are completed by a bachelor's thesis defense. Graduates in food safety should have the ability to: analyze and assess the safety aspects of raw materials and food products in relation to human health, covering the entire food chain; implement and manage food safety control systems and measures in technological processes; carry out research on the quality and safety of food products; work effectively in food enterprises and research laboratories applying quality management systems; consult on food safety and quality issues regarding public health; implement the control of food production chain from raw materials to a consumer assuring public health. After graduation graduates can work in state and international institutions, laboratories, food establishments, supermarkets, catering companies, educational institutions, public health centers, pharmaceutical enterprises as well as the State Food and Veterinary Service and its subordinate institutions. The Faculty of Veterinary Medicine also organizes master's studies in this field.

It is especially interesting to mention The Master of Public Health (MPH) on Faculty of Public Health (FPH) of Lithuanian University of Health Sciences- a study program covers the following teaching subjects: core courses including public health and health care, health policy and strategy, health economics, environmental health, applied epidemiology, human relations and health ethics, management of changes, health law, health information management and research work, applied health psychology and elective courses, including international health management, occupational health care and food safety, public health nutrition etc. Core Curriculum of Master Program in public health was developed during 1997-1999 in the framework of International TEMPUS project. The purpose of the program is to develop public health practice, research and teaching competencies for specialists, who work for health care system. Graduates also can continue studies for doctoral degree. Such competencies as assessment of health determinants, health status of population, planning and implementing of health promotion programs, evaluation of health systems,

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

and health reforms, assessment of the activities of health services and managerial capabilities could be obtained during the program. Graduates of the program may pursue careers in different levels of health service structures (ministries, health departments of municipalities), public health centers, public health bureaus, health insurance funds, public and private health care institutions, international organizations and allied fields. The program structure consist of courses: Public Health and Health Care, Health Ethics and Human Relations, Environment and Health, Health Information Management and Research Methodology, Applied Health Psychology, Applied Epidemiology, Health Law, Research work, Health Policy and Strategy, Management of Changes, Health Economics, Methods of Data Analysis, Practice of Selected Specialization and Final work.

Photo 4.17.1. Brochure on Public Ηealth Master program on LSMU

Public Health Institute is a branch of Vilnius University Faculty of Medicine that is equal to a department in its structure. According to the Medical Faculty's structural scheme, the academic branch that is responsible for all three study cycles - Bachelor's, Master's and Doctoral - is called an institute, rather than a department. The PHI is an institution that has been carrying out scientific research, training scientists. Since 2007, the Public Health | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Institute has been a member of the Association of Schools of Public Health in the European Region (ASPHER). The primary task of the Public Health Institute is to train highly qualified, modern thinking public health specialists that are highly qualified, modern thinking and educated in medical humanities, law and economic fields, and who would be able to:

 Collect, systemize, analyze and critically evaluate health information, to monitor the population's health, to identify and evaluate population's health inequalities and its social and economic determinants, to have knowledge about and be able to apply the principles of epidemiology and other applied scientific research, to evaluate community needs based on objective health information, to identify health problems, to take part in health impact assessment, to apply appropriate, scientific evidence-based solutions for public health issues;

 Perform public health safety, health promotion and education, and other professional activities based on the latest scientific knowledge and practical achievements; be able to identify physical, chemical, social, economic and other environmental factors that affect the population's health and welfare, to have knowledge about and be able to apply the principles of public health safety regulations, as well state and international legal acts, to organize, plan and carry out effective public health safety, health promotion and education, health risk factors and disease prevention programs and interventions.

 To have professional knowledge on the principles of public health policy, health economics, health sociology, health psychology, public health law, to have social and communicative skills that would enable students to organize, plan and carry out the development of public health policy, activities on health promotion and health education and be able to effectively apply them in solving community health issues, as well as evaluate their effectiveness; to be able to clearly and convincingly present the evidence based information on public health policy, health promotion and disease prevention to the general public;

 To apply health, public health, epidemiology, statistics, health policy, management, health economics, and concepts and methods of ethics in practical and scientific research work;

 To plan, organize and carry out epidemiological and other scientific research, while applying qualitative and quantitative research and data analysis methods, to use

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

informational data systems, to provide findings and recommendations for health strategies, health policy, prevention and health promotion programs, the need of public health interventions and their implementation, according to research data;

 To analyze, evaluate and provide recommendations based on evidence based on the indicators of the population's health and its determinants; to organize, carry out and control the evaluation of the effects on public health, as well as the evaluation of the effectiveness and efficiency of health supervision system and public health interventions, such as those of prevention, health promotion and others;

 To take up the leader's position in the field of public health while solving public health issues on community, public, state, and international levels. The Faculty of Medicine organizes bachelor and master studies in the field of public health. Bachelor studies last for four years, 240 credits. The aim of the Public Health undergraduate study program is to train competent public health specialists, public health leaders, who have the skills of strategic, analytical and systemic thinking and evaluation, who demonstrate the abilities to develop health policy and manage effectively; also, the ones who generate new theories and ideas, are able to perform practical and scientific research activities to improve the population’s health and welfare, to reduce health inequalities, to develop ethical, efficient health policy, and public health interventions. Subjects of the study field are Introduction to public health, Microbiology, Genetics and fundamentals of genomics, Fundamentals of health economics and management, Health psychology, Health anthropology, Health sociology, Preventive medicine, Family health, Management of extreme situations, Biostatistics, Radiation protection, Health education and promotion, Social medicine and addiction, Nutrition and food safety, Fundamentals of occupational health, Fundamentals of environmental health, Health safety of children and adolescents, Fundamentals of epidemiology, Fundamentals of scientific research, Law of public health, Arrangement of bachelor degree thesis, Professional practice. Other subjects are: General and analytical chemistry, Fundamentals of human anatomy and histology, Health physics, Philosophy, Foreign language, Human biology, parasitology, Human physiology, Biochemistry, language, Communication skills and Pathology. After the completition of program, students are be able to workin public health centers, public health bureaus, municipal offices of public health, State Food and Veterinary Service, State Labor Inspectorate, State Non-Food Products Inspectorate, Consumer Rights Protection Service, social care institutions, childhood education facilities, municipal medical services, health care institutions, private institutions etc.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

The master studies Public Health last for two years, 120 credits. The aim of the Public Health Master study program is to train competent public health specialists, public health leaders, who have the skills of strategic, analytical and systemic thinking and evaluation, who demonstrate the abilities to develop health policy and manage effectively; also, the ones who generate new theories and ideas, are able to perform practical and scientific research activities to improve the population’s health and welfare, to reduce health inequalities, to develop ethical and efficient health policy. The main subjects of the study field are: Epidemiology and public health, Occupational health, Environmental, food, nutrition and public health, Mother and child health, Leadership and health advocacy, Health promotion, education and public health, Management of public health and economics, Professional practice, Arrangement of master degree thesis. Other subjects are Health policy and public health interventions, Public mental health, Information systems in public health, Ethics and law of public health. The Vilnius Universityalso offers The European Master in Sustainable Regional Health Systems which represents a two-year joint degree master program. Alumni of the program receive a Joint Master Degree in Sustainable Regional Health Systems and master degree in Public Health. This Master´s is a result of close cooperation of four universities (University if Deusto, Spain; Vilnius University, Lithuania, University of Verona, Italy; and Corvinus University of Budapest, Hungary) with administrative institutions and private enterprises of various European regions, providing a mixed Public Health - Business Administration approach. The learning outcomes of this MSc program are: Adequate understanding of the different areas of knowledge in relation to social factors affecting patients in critical and complex situations; Knowledge and understanding of the dynamics of health policies and of alternative health models, their costs and consequences; understanding of the principles, concepts, policies and practicalities at the leading edge of managing progressive health systems and its relevance to broader public policy agendas; understanding of the principles, concepts, policies and practicalities at the leading edge of health entrepreneurship and its relevance to science and technology based business; the ability to search for alternative solutions with an understanding of the social contexts involved, being aware of the consequences of the option chosen; the ability to communicate at the level of the working team, groups and social networks, and also to plan the institutional communication strategy efficiently; the ability to adapt quickly to the new situations of a system undergoing constant change; deep awareness of social factors and their impact on the health system; the ability to adequately use new information and communication technologies and an understanding of the impact these can have on working health contexts, being able to evaluate this impact, and planning its implementation; the ability to

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

adopt values and attitudes placing the patient at the center, and as the key reference for the work done, developing the different strategies of quality in the health system from this perspective; understanding of the value systems (personal, organizational, professional) that shape decision making in health organizations and markets and how values translate into quality of patient care etc. At the end of the Masters Course the students get Joint Master’s degree awarded by all Consortium universities and can work as middle and upper level managers in hospitals and health services as well as in regional and national administrative bodies related to public health planning and management in diverse sectors: health insurance, health financing, strategic planning, etc. According to program structure, it is important to mention that courses include: entrepreneurial mindsets; managing sustainability; critical skills set; trade off between equity and efficiency; Delivering progressive health systems; Strategic asset management; Quality and the consumer; European health legislation processes; Managing innovation; Sociological perspectives on population health; Health advocacy and Managing innovation. On Lithuanian sports university there is master program in Physical Activity and Public Health. The aim of this program is to prepare public health practitioners, researchers, developers and experts of health enhancing physical activity programs and projects as well as specialists who are able to make and develop strategies and health promotion policies. The specialists will be able to manage and pursue their activities in educational, social, public and private sectors.The modules which are offered are Advanced Methods in Epidemiology and Modern Public Health (10 ECTS) / Environmental and Occupational Health (10 ECTS) / Health Policy, Strategy and Management of Changes (10 ECTS) / Health Economics (10 ECTS)/ Research Methods and Statistics (10 ECTS)/ Scientific Intership (10 ECTS) / Specialization (Aging/Nutrition)* (30 ECTS)/ MASTER THESIS, Reflection (30 ECTS).The main competences provided after the completition of a program are: Scientific knowledge and management of ideas/ Communication: social and academic integration/ Leadership and change management/ Continuous professional learning and personal development/ Evaluation and monitoring of trends and determinants in health indicators/ Population and community epidemiological research and statistical analysis/ Development, management and evaluation of preventive health promotion and physical activity enhancing program/ Health promotion policy development. Regarding to career opportunities, the graduates of the Physical Activity and Public Health degree program are able to perform research, organizational, expert or managerial type of work in public institutions (public health sector, academic and educational institutions, local health departments and health care institutions) and private business structures (health and wellness centers).

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Klaipėda University started its academic activities with three faculties (those of Marine Engineering, Pedagogy, and Humanities and Natural Sciences) and about 3,000 students. It celebrated its 25th anniversary with 4,500 students in the Faculties of Marine Engineering and Natural Sciences, Humanities and Education Sciences, Social and Health Sciences, as well as in the Arts Academy, the Institute of Continuous Studies, and the Institute of Baltic Region History and Archaeology.

The Faculty of Health Sciences consists of six departments. These are: Medical Technology, Rehabilitation, Recreation and Tourism, Nursing, Social Work, Public Health. There is also The Health Research and Innovation Centre.

Table 4.17.3.The Faculty of Health Sciences, Klaipėda University, study programs.

Bachelor’s Degree Programmes Master’s Degree Programmes

Nursing (EN, 4) Health Care Management (EN / RU, 2)*

Recreation and Tourism (EN, 4) Public Health Education (EN, 2) Social Work (specialization – Social Work in the Community; Social Work in Health

Social Work (EN, 2)

Care) (EN, 3,5)

Joint Master in International Tourism and

Events Management (EN, 1,5)

Master program Public Health Education Program is oriented to the recent individual and public health needs and sustainable interaction with education. The program seeks to develop effective, evidence-based oriented public health care specialists, who are able to organize and implement not only the functions and activities of the public health care specialist, but also to organize and carry out non-formal child and adult educational programs and activities. It is based on the health and education policy documents and programs, strategies, goals and objectives of the European Union and the Republic of Lithuania. The rapid changes of the society needs and the development of the individual and the public health care influences the areas and activities of the public health professionals. The program has been established having on mind the fact for the implementation of the health education and health promotion strategies and programs there is need for the high quality specialists with basic biomedical and/or social sciences

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

education, who are capable to work in the multi-professional teams, and through formal and non-formal educational activities to ensure better public health. Graduates could work as specialists in health education and health promotion, as project managers in kindergartens, schools, health care departments of municipal administration, in health care institutions, NGO, and national and local institutions responsible for national/local public health policy development and implementation.

The list of the courses is listed below.

Table 4.17.4. A list of courses on Master program Public Health Education Program.

1 semester 4 semester

Master Thesis (B680M022)

Health Care Ethics and Law (B680M004) Courses -group 1 Primary Health Care and Community

Innovations in Education (B680M016)

Health (B680M008) Non-formal Children and Adults Education Sociology of Health and Education

Modelling (B000M065) (B680M018) Research Methodology and Management Health Care Organization and

(B680M014) Management (B680M001) Health Education Theories and Modelling Addiction Prevention in Community

(B001M012) (B680M101) Active and Healthy Ageing 2 semester

(B680M015)

Children and Teenage Health (B680M011) courses –group 2 Health Information Technologies in Sociology of Health and Education Educational Process Management

(B680M018)

(B680M017) Health Policy and Strategic Management Primary Health Care and Community

(B680M019) Health (B680M008) Health Care Organization and

Research Paper 1 (B680M020)

Management (B680M001)

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Addiction Prevention in Community 3 semester

(B680M101) Health and Safety of Risk Groups and Active and Healthy Ageing

Educational Peculiarities (B680M012) (B680M015) Training and Management of Health

Education Projects (B001M014) Health Care Quality Management

(B680M100) Leadership in Health Care Education

(B000M064)

According to the OECD report from 201611 on Lithuanian schools, following issues are of concern in the future: emigrations put pressure on already limited budgets, too big reliance upon schools led by municipalities, disparities in quality of education when comparing rural and urban areas, as well as limited number of teachers and their dispersion across the country. 4.17 Luxemburg

Educational system in Luxembourg is divided to: early schooling, fundamental school, general secondary school, technical secondary school and higher and university education. According to the Law on Compulsory Schooling (2009), every child between age of 4 and 16 is obliged to go to school. Majority of schools are free public schools. Existing private schools follow the same syllabuses and prepare students for the same diploma. This influences the schools’ autonomy, since teachers have to follow the form which does not leave them or the schools space for maneuver. In order to fight some of the issues that arose in terms of quality of education, there were two reforms: reform of vocational education and training (2008, amended in 2014) and reform of fundamental education (2009)12. First of them focused on the lack of connection between the needs of the market with vocational education through changes such as: financial compensation for internship and extension of basic trainings to all professions. Second reform focused on introducing certain innovative approach: two-year learning

11https://www.oecd.org/edu/school/Lithuania%20-%20Summary%20-%20ENG.pdf 12https://www.oecd.org/luxembourg/Education-Policy-Outlook-Country-Profile-Luxembourg.pdf, page 4 | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

cycle, increase in school autonomy, greater involvement of parents, improved student evaluation and introduction of school development plans.

Higher education in Luxembourg was until recently non-existing. Students would go to neighboring countries to study. Since 2003, University of Luxembourg was founded with three faculties: the Faculty of Science, Technology and Communication; the Faculty of Law, Economics and Finance; the Faculty of Language and Literature, Humanities, Arts and Education. There are other universities founded in the last two decades: Open University Luxembourg, Sacred Heart University, Miami University and Lunex University. Two of them offer to obtain a diploma by either doing evening classes or via internet or distance learning. Although, it does not have a long tradition in higher education organized by state, and especially no experience in medical faculties, Luxembourg has quite impressive results and it is dedicated not just to distance learning, but also life-long learning.13

Luxembourg Institute of Health has 3 departments, 365 employees of 35 nationalities.14 Each department has its own research units, employing technicians and doctoral and post- doctoral researchers. Additionally, departments offer additional training in ICT, statistics and metrics and public health issues to the researchers. The Department of Population Health at Luxembourg Institute of Health is an interdisciplinary research centre focusing on epidemiology and public health research across a wide range of areas including cardio- metabolic conditions, sports medicine, human bio-monitoring, health economics and clinical investigations. By the evidence they generate, they aim at tackling the major causes of morbidity and mortality, improving quality of life and informing clinical and public health guidelines in the country.15 “The overall rate of adult participation in lifelong learning (14% in 2014) is above the EU average (9%) and close to the average target of 15% set in the Europe 2020 education and training strategic framework. Yet, participation in lifelong learning for adults with lower educational attainment stands at only 7.3%.”16 Nonetheless, lifelong learning is recognized by Luxembourg not just in strategies and other documents related to education, but also in

13http://www.lifelong-learning.lu/Accueil/en 14 Institute of Health in Luxembourg can be accessed at: https://www.lih.lu/. 15 Department of Population Health, for more information, visit the following link: https://www.lih.lu/jobs/department/doph-department-of-population-health-779 . 16https://www.oecd.org/luxembourg/Education-Policy-Outlook-Country-Profile-Luxembourg.pdf, page 6 | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

other fields. Thus, it is also one of the aspects to be taken into serious consideration within National Plan for Smart, Sustainable and Inclusive Growth 2020.17

According to PISA 2015, Luxembourg performed below OECD average in reading, mathematics and science. 4.18 Malta

Structure of the education system in Malta is as follows: primary, lower secondary, upper secondary, vocational secondary and higher education. Compulsory studies are from the age of 5 to 16. Some of the leading legislative acts governing in this field are: Education Act (1991) and Mutual Recognitions of Qualifications Act (2004). When it comes to the higher education, there are several educational institutions funded by state: Giovanni Curmi Higher Secondary School, Sir Michelangelo Refalo, Sixth Form, Junior College, MCAST and University of Malta. University of Malta offers several faculties related to the medicine: Faculty of Dental Surgery, Faculty of Health Sciences, Faculty of Science and Faculty of Medicine and Surgery. “Every year, the Ministry for Health presents a consolidated business plan and a human resource plan based on the needs of all health facilities and departments. All capacity building is thereafter negotiated with the Ministry for Finance, as it is responsible for coordinating all public sector requests. Long-term human resource planning typically involves health authorities and education authorities collaborating with the University of Malta to decide which courses should be offered and at what frequency.”18 At the undergraduate level, University of Malta does not provide a Bachelor degree in Public Health, but there is a course ‘An introduction to Public Health’ for undergraduate medical students covered by the curriculum during their clinical training19. Department of Public Health at Faculty of Medicine and Surgery, University of Malta, offers 3 postgraduate courses in Public Health leading to the conferment of the title of Master of Science in Public Health. The first one requires students to attend it full-time and do the research, the second is also part-time course and students are required to conduct a

17 Within the National Reform Programme of the Grand Duchy of Luxembourg under the European semester, see the link: http://ec.europa.eu/europe2020/pdf/csr2016/nrp2016_luxembourg_en.pdf 18http://www.euro.who.int/__data/assets/pdf_file/0010/241849/HiT-Malta.pdf, page 21 19 Undergraduate study-unit in Public Health: https://www.um.edu.mt/ms/publichealth/courses | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

research, and the third one is part-time evening course. The main difference among these is that the first course lasts 3 semesters, and the other two take 5 semesters to complete.The course content is similar to that offered for the membership examination of the Faculty of Public Health in the UK, from which it was originally based. The main areas of the course are: Research Methods - Epidemiology and Qualitative Research, Medical Statistics, Health Information Science, Health Promotion, Organization of Health Care Systems and Management, Environmental Health, Sociology of Illness, Applied Epidemiology, Communicable and Non-communicable Diseases, Social Policy and Health Economics.20 Furthermore, Department of Health Services Management offers five specializations in the field of health management and leadership. These are all courses leading to the award of the Master of Science in Health Services Management, but the sole difference is made by taking into account the student’s attendance options (full-time (by researching), part-time, part-time day, part-time evening, part-time day (by researching) and consequently, the duration of these courses range from 3 semesters for a full-time students up to 6 semesters for part-time day (by researching) students.21 The Department of Health Services Management has been training and producing managers and leaders in health care for the past 20 years. Many of the senior managers and leaders in the public and private health care sectors have undergone training and instruction through one of the programmes run by the Department as qualifications in management are a prerequisite for many middle and senior management posts today. Malta has a Strategy for Life-long learning with rather ambitious and comprehensive goals for the improvement of education system. The following courses are governed by the Directorate for Lifelong Learning, at Ministry for Education and Employment: Cultural Awareness, Digital Competences, Family Learning, Languages, Mathematics, Science & Technology, National Diploma in Teaching Adults, Sense of Initiative & Entrepreneurship, Social, Health & Civic Competences, Visual and Performing Arts, Vocational Education & Training. 22

20 Master in Science in Public Health at University of Malta (for detailed overview): http://www.um.edu.mt/ms/programme/PMMSCPHLFTR5-2015-6-O 21 Postgraduate Courses offered by the Health Services Management Department at University of Malta http://www.um.edu.mt/courses/list.php 22 Life-long learning in Malta: https://www.gov.mt/en/services-and-information/business- areas/education%20and%20learning/pages/lifelong-learning.aspx | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Education Strategy of Malta23 proclaims four broad goals for the period 2014-2024: 1) reducing gaps in educational outcomes between boys and girls, as well as between students from different schools; 2) support to children at-risk-of-poverty and low-socio-economic status in educational achievements; 3) increase participation in lifelong learning and adult learning and 4) raise levels of student retainment and attainment in further education and training at all levels.

According to PISA 2015, Malta performed bellow the OECD average in science, mathematics and especially low in reading. According to National Statistics Office of Malta, Maltese government has spent €56,483,000 on Health in the sub-category of “Personal Emoluments”, €15,217,000 in sub-category “Operational and Maintenance Expenses’, €36,847,000 for ‘Programmes and Initiatives’ and €14,194,000 for ‘Contributions to Government Entities’ in the Health domain. Total expenditure on Health in the first quarter of 2017 is €124,902,000.24 4.19 Netherlands

4.19.1 The Educational System, Structure and Management, Students Demographics, Legislation

The Ministry of Education, Culture and Science (OCW) has the political responsibility for the educational system and is bound by national legislation: the Higher Education and Research Act and the Student Grants. The Ministry of Education, Culture and Science is responsible to a large extent for the financing of the education system, defines the general education policy and specifies the admission requirements, structure and objectives of the education system on general lines. In addition, the Ministry of Health, Welfare and Sport and the Ministry of Economic Affairs are involved in the content of higher education. At all levels (primary, secondary and higher education), there is a general trend towards fewer rules and regulations, so that

23https://education.gov.mt/en/resources/Documents/Policy%20Documents%202014/BOOKLET%20ESM%202014- 2024%20ENG%2019-02.pdf 24 National Statistics Office of Malta. News Release for January –March, 2017: Government Finance Data. Published on 28 April 2017. Accessed on 30 April, 2017 at: https://nso.gov.mt/en/News_Releases/View_by_Unit/Unit_A2/Public_Finance/Documents/2017/News2017_074. pdf | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

institutions can take responsibility themselves for the implementation of government policy.

The Dutch education system consists of 8 years of primary education, 4, 5 or 6 years of secondary education (depending on the type of school) and 2 to 6 years of higher education (depending on the type of education and the specialisation). Both public and private institutions exist at all levels of the education system; the private institutions are in most cases based on religious or ideological principles. Dutch higher education has a binary system, which means that a distinction is made between research oriented education and higher professional education. This difference in orientation has continued to exist after the introduction of the bachelor’s-master’s degree structure in 2002. Research-oriented education takes place primarily at research universities and the higher professional education at universities of applied sciences. As well as the different objectives, each of the two types of education has its own admission requirements, programme duration and titles.Education is compulsory in the Netherlands between the ages of 5 and 16.

4.19.2 Public Health Educational Institutions

The Erasmus MC – Netherlands Institute for Health Sciences (NIHES): Contains the department for Public Health. The main objective of the department is to conduct leading research and education that will have a discernible impact on population health at the local, national, and international level. Its goals include high-quality scientific publications on relevant and innovative topics, and disseminating knowledge and expertise to support evidence-based public health. Netherlands Public Health Federation: The NPHF is an umbrella association for all public health related associations and institutions in The Netherlands. It was established in 2000 with the aim to strengthen public health in The Netherlands.

The institutions which offer Public Health related degrees are listed below in ‘3. University programs in Public Health both undergraduate and postgraduate’.

Care and Public Health Research Institute (CAPHRI):CAPHRI is one of Maastricht University’s largest research institutes, with a focus on Healthcare Innovation and Public Health Research. CAPHRI provides high quality multidisciplinary research and teaching aimed at the improvement of the individual's quality of life and the population's health

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

through responsible innovation in public health and health care. As a PhD Graduate School CAPHRI facilitates talented Master graduates to obtain a PhD by offering high-quality supervision by committed researchers of CAPHRI.

4.19.3 University Programs in Public Health both Undergraduate and Postgraduate

Studies in the field of Public Health:

Bachelor:

 Bachelor in European Public Health (EPH) o At the Maastricht University Master:

 Master in International Health (MIH)

o At the Royal Tropical Institute (KIT)

 Research Master in Health Sciences specializing in Epidemiology o At Erasmus MC Netherlands Institute for Health Sciences – Erasmus University Rotterdam

 Research Master in Health Sciences specializing in Public Health o At Erasmus MC Netherlands Institute for Health Sciences – Erasmus University Rotterdam

 Master of Public Health - International Course in Health Development

o At the Royal Tropical Institute (KIT)

 Master of Public Health o University of Amsterdam – Institute for Biodiversity and Ecosystem Dynamics (IBED)

 Master of Health Sciences

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o At Vrije University Amsterdam

 Master of Research Master in Health Sciences o At Maastricht University

PhD:

 Research Master in Health Sciences specializing in Public Health o At Erasmus MC Netherlands Institute for Health Sciences – Erasmus University Rotterdam. In addition, different institutions offer various courses in the area of public health for further education and advanced training. For example a short course in Global Health at the University of Groningen Summer Schools.

4.19.4 Continuing Education, Life Long Learning

The Netherlands ranks among the EU top five for highest participation rates in lifelong learning, i.e. enrolment in education or training by people aged 25 to 64. Among survey respondents, those who indicate having received training and education for work or leisure are predominantly the highly educated, people in their late twenties, and those working in financial services, health care and education. Among Dutch survey respondents aged 25 to 64, nearly 18 percent (equivalent to 1.6 million people) stated they were involved in education or training for either work or personal reasons in 2014. This might be a workshop, Spanish language training or a course in art history, but might also be a complete course in higher education. Ranked higher than the Netherlands for participation in lifelong learning, are France and the Scandinavian countries.

Highest participation rate among highly educated and those working in financial services:In 2014, the Netherlands had a relatively larger share of highly educated persons taking training or education than less educated. This is partly related to their professions: medical specialists, lawyers and teachers for example more often face developments in their work which make extra training necessary or even compulsory. Most extra training is received by people working in financial services. There are also large differences according to age: people in their late twenties and thirties participate relatively more often in

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

education or training than older people. Among this younger group, some have been enrolled in long study programmes yet to be completed. In addition, young people are more likely to need training in their new (first) job to acquire specific company or job related knowledge or skills, such as induction programmes, compared to more experienced employees.

Working people mainly learn to improve work performance:More employed than unemployed people indicate they are enrolled in education or training. Their main reasons for doing so are to upgrade their professional skills and enhance their career prospects. People who have taken long-term work-related training are relatively more successful in receiving promotion or higher salaries compared to those taking short-term training. Informal learning:Aside from receiving education or training courses, people can also learn in an informal manner, i.e. not as a planned and institutionalised activity but for instance by reading a book about the country they wish to visit or by learning from a co-worker about their company’s production process. Informal learning is not covered in the European indicator for lifelong learning but is fairly common in practice.

Continuing education for nurses often takes place on the initiative of the healthcare institutions where nurses are employed. The national association of Nurses and Carers in the Netherlands (V&VN) has developed a “Quality 128 Health systems in transition The Netherlands Register for Nurses”. On a voluntary basis, nursing staff can record their training and professional development activities online in the quality register, which offers individuals the chance to compare their skills with professionally agreed standards of competence.

4.19.5 Public Health Professionals Certification (Legislation)

Medical education is provided at each of the eight Dutch universities, while nurses can be educated at an intermediate, higher or academic level, depending on the professional profile. The quality of healthcare professionals is safeguarded by obligatory registration and by licensing schemes maintained by professional associations. The official certification in Public Health professions is mainly handled by universities. The Netherlands offer a Bachelor, Master and PhD Degree in the field of Public Health. Certified courses to gain ECTS or participation certificates are also offered by a variety of institutions.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.19.6 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

The Netherlands have a collaborative ICT organisation for Dutch education and research called SURF. SURF offers students, lecturers and scientists in the Netherlands access to the best possible internet and ICT facilities.

Main ICT developments: The Strategic Plan of SURF outlines the main ICT developments that will be impacting education and research over the years ahead. It sheds light on the key themes and priorities that will be important in education and research in 2015-2018:

 A federated e-infrastructure for education and research

 Optimally managing data

 Customised education

 Impactful research

 Reliable and secure environment

 Efficient and sustainable business processes In recent years ‘Distance Learning’ becomes more popular in the Netherlands. Distance or online learning is a mode of study that allows students to study most or all of a course without attending at a campus-based institution. Distance can refer to both material and interaction. Distance learning provides access to learning when the source of information and the learners are separated by time and distance, or both.During this type of education students communicate with the faculty and other students via e-mail, electronic forums, videoconferencing, chat rooms, bulletin boards, instant messaging and other forms of computer-based interaction.The programmes often include an online training system and tools to produce a virtual classroom. The tuition fees for distance learning vary from institution to programme to country. It is certain that the student saves expenses related to accommodation and transportation, because you can maintain your current living expenses. Distance learning is also a great solution for people that already have a job, and still want or need further education. Universities started to offer certified courses as well as studies online. Examples are:

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Epidemiology Postgraduate, M.Sc. at Utrecht University

 Nutritional Epidemiology and Public Health, M.Sc. at Wageningen University

 Introduction to Epidemiology, Certificate, Utrecht University

4.19.7 Expenditure and Economics

In 2015 the Gross Domestic Product(GDP) of the Netherlands was approx. EUR 700 billion. The healthcare expenditure in EUR was approx. EUR 70 billion. That were approx. 10% of GDP. The total number of people employed in the healthcare field was roughly 1,1 million. Expenditure in education (2013):

Public expenditure on education: 12.1 % Expenditure in pre-primary: 6.9 % Expenditure in primary: 23.5 % Expenditure in lower secondary: 22.1 % Expenditure in tertiary: 28.9 %

4.19.8 Challenges and Future Perspectives

Almost 7% of the Dutch population, or well over 16% of the working population, is active in the healthcare sector; since the early 2000s the total number has grown by about one- fifth. Skewed distribution of providers is not a major problem in the Netherlands, although in some areas, both in big cities and the countryside, additional efforts need to be made to match demand and supply of GP care. The traditional work settings and division of labour between medical professions has changed over the years. Professionals in primary care increasingly work in larger organizational settings (such as primary healthcare centres), where they are supported by allied staff and managers, and also increasingly work in multidisciplinary teams. Community pharmacists increasingly work in structured collaboration with GPs in their catchment area. These new modes of care provision require new skills and change the work arrangements. As a result of the transfer of tasks or substitution, new occupations exist, such as practice nurses, nurse practitioners, nurse-specialists and physician assistants.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Geographical inequalities of healthcare labour supply are minor in a small country such as the Netherlands. However, regional differences in demographic development have an increasing impact on the demand for health services. 4.20 Poland

4.20.1 The Educational System, Structure and Management, Students Demographics, Legislation

Education system in Poland:Education is compulsory for children from the age of 6 to 18 years old. Public schools are tuition-free; however, there are a number of paid private schools. Kindergartens:Kindergartens enrol children from the age of 3 to 6 years old. Parents may choose not to send children to kindergarten, if they are less than 5 years old. Moreover, it is compulsory for every child to participate in one-year long preparatory class, before they are promoted to the elementary school level.

Elementary school:6-year-old children enter six-year period of education at the elementary school level. (Since 1 of September 2015 every 6 years old children will be obligated to go to school.) Curriculum of the first three grades does not cover multiple subjects (so called integrated education) and the classes are taught by a single home room teacher. This gives children time to adapt to the school environment and learn to read and write. Teaching specific subjects does not start until the fourth grade. In the sixth grade, Central Education Commission verifies the knowledge and skills of the pupils during the nation-wide examination. The results of the examination have no influence on completion of elementary education or enrolment to public gymnasiums, which emphasizes the informational purpose of the exam. The main admission criterion for gymnasium enrolment is pupil’s place of residence.

Gymnasium (lower secondary level school):Education at lower secondary level takes three years. Gymnasiums are attended by children from the age of 13 to 16 years old. Education at this level assumes general character and is concluded with a nation-wide examination divided into three parts: humanities, mathematics and environmental sciences, and foreign languages (elementary level – compulsory for all exam participants, extended level – compulsory for children, who have been taught foreign language since elementary school).

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

There is no specific level of points required for passing the exam; however, its results may affect the admission to specific secondary schools.

Upper secondary level schools:Upper secondary level schools differ in scope and length of the education and type of the final examination upon its completion:

 Basic vocational school (16 to 18 / 19 years old) - graduates receive a diploma certifying vocational qualifications obtained during the education process. They may continue education in a supplementary general secondary schools and obtain additional qualifications on technical cources.

 Three-year general secondary school (16 - 19 years old) concluded with the final maturity examination (matura). Each examinee is obligated to attend exams in Polish, mathematics, and one of the foreign languages. Moreover, examinees choose between extended and basic forms of the exam. Some schools offer bilingual classes, which enables student to participate in the International Baccalaureate Diploma Programme.

 Four-year technical secondary school (16 - 20 years old) concluded with the vocational examination. The technical school offers a possibility to participate in the final maturity examination.

 Three-year special education schools established for students with special educational needs arising from mild or significant intellectual disability or students with multiple disabilities. Upon graduation, students receive diplomas certifying their work readiness. Post-secondary schools:Post-secondary schools offer complementary education for the graduates of the secondary level education. Completing this type of school takes two and a half years at most.

Higher education:Polish higher education system is based on the Bologna process, which comprises:

 Professional higher studies (three to four years) – graduates obtain professional degree of licencjat or inżynier (in the field of engineering, agriculture or economics), which is the Polish equivalent of a bachelor’s degree.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Two-year master studies – graduates obtain a professional degree of magister, which is the Polish equivalent of a master’s degree depending on the course profile of the studies.

 Five-year master studies e.g. law, psychology, and medicine.

 Doctorate level studies

4.20.2 Public Health Educational Institutions

National Institute of Public Health (NIPH): The mission of the National Institute of Public Health-National Institute of Hygiene is to protect the health of the population through actions taken in the field of public health, including research and training. This refers to the monitoring of biological, chemical and physical risk factors in food, water and air as well as diseases and infections control. NIPH-NIH offers expertise for the government, NGOs and civil society in the field of public health, risk assessment and indication how to avoid risks. The Institute also conducts research of sera and vaccines quality. The NIPH offers courses in the field of Public Health.

Department of Health Promotion and Postgraduate Education:The assessment of health and educational needs of population, the analysis of social, environmental and behavioral health determinants, development of standards of good practice for the health promotion and health policy. The Institute of Public Health: in the Faculty of Healthcare Jagiellonian University Medical College is the former Cracow School of Public Health, a name which has become engrained in the memory of many people, as it was the first school of public health in Poland. Both under the former and the present names, we conducted and continue to conduct research and development activities as well as training within the broadly understood field of public health. The focus of interest and work is issues relating to those aspects of health care that fall outside medicine, such as: health organization and health economics, social aspects of health care systems, administration and management, epidemiology, health promotion, issues of community health, managing pharmaceuticals and medical materials, computerisation and issues relating to the dissemination of information within health care.

As an organisational unit of Jagiellonian University, the institute conducts large-scale educational activities, such as undergraduate and Master's courses in Public Health. They also offer postgraduate courses and specialist training.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Poland has 19 universities including the following 12 medical universities: Jagiellonian University Medical College in Krakow, Medical University of Bialystok, Medical University of Gdansk, Medical University of Lodz, Medical University of Lublin, Medical University of Silesia, Medical University of Warsaw, Nicolaus Copernicus University – Ludwik Rydygier Collegium Medicum in Bydgoszcz, Pomeranian Medical University in Szczecin, Poznan University of Medical Sciences, Wroclaw Medical University, University of Warmia and Mazury in Olsztyn, Faculty of Medical Sciences.

4.20.3 University Programs in Public Health both Undergraduate and Postgraduate

The Institute of Public Health: is trying to combine in a sustainable way the knowledge of the bio-medical field with economy, law, management, sociology and psychology in its educational program. The attainment of high quality equilibrium requires the development of a multidisciplinary scientific environment and a mutual interest in the subject matter, which is so unique in the Polish academic tradition. The challenge facing the executors of such a sustainable educational program not only calls for effort but also creates new research perspectives. Master of Public Health studies were launched at the Institute of Public Health in 1997. The curriculum reflects to a great extend the former, many-year experience of postgraduate Public Health training and strong pursuit of the IPH academic staff provide the education which meets the criteria set up by the Association of Schools of Public Health in the European Region (ASPHER). After finishing the Public Health studies, a graduate should assume the role of an organizer and executor of health care programs at the population level with the attention turned to such activities as: Health promotion and health education, early disease diagnosis, Elimination of social effects of disease, Multi- aspect cost-benefit analysis of programs and strategies of overcoming diseases. At the Jagiellonian University Medical College it’s possible to study:

 Bachelor of Public Health: The goal of bachelor studies is providing the education, which enables undertaking the following professional positions and vocational life-long training trends:

o executor of health care programs o health educator manager and trainer of teams executing the tasks within the health care programs staff

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o member of organizational health care units o staff member of health promotion and prevention departments in administrative health care units

 Master of Public Health:

Candidates for Master of Public Health studies /Graduate of Bachelor of Public Health studies should possess the following knowledge and skills: o knowledge of basic medical problems related to health problems

o knowledge of health care system knowledge of basics of law, economics and management o knowledge of basics of social science

o knowledge of research methodology

o basic knowledge related to health promotion issues o ability to search and use scientific literature ability to share knowledge with others o ability to react to the progress in knowledge and changes in the health care system o ability to work in interdisciplinary teams o ability to use a foreign language

Courses (Graduate and PostgraduateStudies)

Public health studies (taught in Polish):

 Basics of economics and finance

 Economics

 Introduction to health economics

 Economics of health care sector

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Macroeconomic determinants of health care financing

 Economics of health insurance

 Economic analysis in health care

 Financial management and management accounting

 Social policy

 Targeted social policy

 Social and health insurance

 Protection against the risk of disease

 Social, medical and economic problems of disability

EUROPUBHEALTH Specialization Health Economics and Governance of Health System (taught in English)

 Funding of health system and financial methods

 Determinants of health and health care expenditures

 Health insurance

 Economic analysis of health care and public health programmes

In addition, a wide variety of Graduate seminarsare offered.

4.20.4 Continuing Education, Life Long Learning

In Poland, adult education is often referred to as ‘Continuing Education´, which is defined as ‘education in schools for adults as well as the development of general knowledge, vocational skills formation and ability development in out-of-school forms by persons who have graduated from compulsory education´. The system of Continuing Education in Poland is often seen by the terms ‘in school´ or ‘out- of-school´. On the whole these phrases quite closely relate to the idea of formal and non- formal education, as ‘in school´ comprises education in institutions and qualification driven

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

vocational training, whereas ‘out of school´ is more independent and informal. Adult ‘in school´ education is provided in primary schools, gymnasia (secondary schools), basic vocational schools, upper secondary and post-secondary schools, and in higher education establishments, although primary schools for adults are very rare. Postgraduate studies are also considered to be a form of continuing education, and are organised by public or non- public higher education institutions, research units and by units of the Polish Academy of Sciences. Over the past few years changes are emerging which show a new desire to make adult education more accessible, by developing systems - for example - with e-learning. However it is still true that most Continuing Education is aimed towards vocational training in one form or another, especially in relation to helping people adjust their skills to the needs of a rapidly developing market. The Minister of National Education is responsible for co-ordinating adult education, primarily through the activities of the Department of Vocational and Continuing Education, which is responsible for many of the aspects of adult education. Activities which fall into this remit include the establishment and running of public continuing education centres, public practical training centres and in-service training centres, as well as for the definition of principles underlying the acquisition, complementing and improvement of vocational qualifications. They also have responsibility for the co-ordination of the core curriculum for vocational training, evaluating the continuing education system and the accreditation system for education centres. Innovations in adult education, particularly related to vocational training, have been progressing over the past years within the context of the European Qualifications Framework. This includes developing qualification standards, modular curricula and educational packages, and was begun in 2008 with a view to continuing throughout the coming years. There has also been a growing concern for developing professional standards, and as such over 250 National Professional Qualification Standards have been developed by the Institute for Sustainable Technologies - National Research Institute in Radom between 2006 and 2008. All physicians, dentists and pharmacists must participate in continuing education, collecting points for the completion of continuing education courses; this activity is monitored by the relevant chambers. Physicians, dentists, nurses, midwives, pharmacists and laboratory diagnosticians who have been inactive for more than five years must notify

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

the relevant chamber and be retrained at their own expense. Failure to do so may result in a suspension of their right to practise. 4.20.5 Public Health Professionals Certification (Legislation)

The Minister of Health grants accreditation to health care institutions on recommendation of the Accreditation Board, in the form of accreditation certificates, which are valid for three years. Several medical professions9 are regulated by separate legal acts in Poland, which set out, among others, certification requirements and specifications concerning specialist training and continuing education. Other medical professions are not regulated separately and may currently be practised by people without formal qualifications, who have learnt their tasks on the job or completed relevant education or vocational training programmes. Some attempts to formalize the prerequisites for these positions have been made. For example, the PO-led government proposed a bill to regulate and establish a register for selected medical professions; however, the bill has not advanced since the last draft was circulated in May 2010. There are four statutory organizations responsible for registering and licensing qualified medical personnel in Poland: the Chamber of Physicians and Dentists, the Chamber of Nurses and Midwives, the Poland - Regulation Page 6 / 10 Pharmaceutical Chamber and the Chamber of Laboratory Diagnosticians. Membership is compulsory for all practising medical professionals, and both regional and national chambers maintain registries of all professionals who have the right to practise or to a specialist title. Registers of physicians and dentists undergoing specialization training are maintained by the centres for medical personnel training at the ‘voivodeship’ public health centres. Since there are no registries for other medical professions, it is difficult to assess the number of professionals working in medical fields other than those mentioned above. 4.20.6 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

E-Learning in Poland has been a focus of Higher Education institutions over the past decade, as they have been increasingly working towards developing effective e-learning platforms. This is backed by the Ministry of Education, although currently only targeted at formal education and Higher Education institutions. However, there seems to be increasing energy in the field, and in 2006 the Association for Academic E-Learning was established in

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Poland, who aim to participate in the process of raising the level of education of Polish society and the development of the idea of an information society and to promote and develop e-learning in academic communities and public administration.

 The role of e-learning:

o Fully e-learning study programs (or single courses): students obtain access to e-learning contents put on e-learning platform or distributed on CDs. Students are usually supported by tutors that use various communication tools (chat, discussion forum, e-mail, virtual classroom, videoconferences). A few times a year students have a presence phases at the university, during which they take exams, participate in kick-off classes. This model was successfully introduced only by few Polish universities. o Blended learning study programs (or single courses): students attend traditional led classes, which are supported with e-learning contents. This is the most popular model in Poland, at this moment majority of universities initiated some activities in this area.

o Traditional study programs supported by ICT in the area of communication and collaboration: this model is usually used by institutions that haven’t developed e-learning contents so far.

 E-learning content distribution method: o Computer based training - Until now it was more popular model due to underdeveloped IT infrastructure (e.g. problems with Internet access in some rural areas). o Web based training - Currently it becomes more and more popular due to some improvements in IT infrastructure, as well as the increased availability of cost-effective elearning solutions.

 E-learning solutions used: o Self-developed platforms – it was quite common a few years ago that universities started to develop own solutions instead of purchasing costly commercial ones. However due to the need for continuous investment in self-developed platform to follow new standards, decreasing prices of

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

commercial solutions, appearance and popularization of open source platforms (e.g. Moodle) only few universities still continue to develop own platform. o Open source platforms – quite popular in Poland is Moodle, that can be easily adapted to the particular needs of a university. Moodle implementations however are rarely integrated with other university systems and their usages lack standardization and coherence between various courses. o Commercial platforms – 2-3 years ago commercial e-learning solutions were in most cases to expensive for universities to be used. Certainly there were some universities that managed to negotiate favorable conditions and are using commercial ones. Since 2005 the Polish platform (WBTServer) offered by 4system gained wide popularity among Polish universities due to the low price and advanced functionality. Commercial platforms usually are integrated with other university systems and its usage seems to be the most professional compared to self-developed and open source platforms.

4.20.7 Expenditure and Economics

Poland’s overall investment in educational institutions at most levels of education is below the OECD average (4.8 % of GDP, compared to the OECD average of 5.3 %). Only at post- secondary non-tertiary level is Poland’s investment in educational institutions equal to the OECD average (0.1 % of GDP) (Figure 4.21.7.1.). Between 2000 and 2012, expenditure on education as a percentage of GDP decreased by 0.1 percentage points (compared to the OECD average of an increase of 0.4 percentage points). In Poland, almost all expenditure on educational institutions across all levels of education comes from public sources (88.1 % in 2012, compared to the OECD average of 83.5 %), while the share of private expenditure (11.9 %) is below the OECD average (16.5 %). Private expenditure is highest at the tertiary level (22.4 %, compared to the OECD average of 30.3 %). From 2005-12, public expenditure at primary, secondary and post-secondary non-tertiary level increased by 15 % (above the OECD average of 14 %), and at the tertiary level it increased by 14 % (below the OECD average of 33 %). Private expenditure at primary, secondary and post-secondary non-tertiary level increased by 38 % (just above the OECD average of 37 %) and at the tertiary level it decreased by 7 % (compared to an average increase of 26% across OECD countries). Annual expenditure per student in public institutions from primary through | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

tertiary levels in 2012 was USD 7 398, below the OECD average of USD 10 220. However, Poland is catching up, as expenditure per student has increased faster than the OECD average at all levels of education, boosted by an overall drop in student population. At the primary, secondary and post-secondary non-tertiary level, there was an increase of expenditure per student of 62 % (compared to the OECD average of 21 %), while the number of students decreased by 23 % (compared to the OECD average of 3 %).

Figure 4.21.7.1. Expenditure on educational institutions as a percentage of GDP, by level of education (2012) Source: OECD (2015), Education at a Glance 2015: OECD Indicators, OECD Publishing, Paris.

4.20.8 Challenges and Future Perspectives

With one exception, the Polish schools reported relatively moderate emphasis on competences within socio-economic determinants of population health, but, taken together, the combined programmes would be comprehensive (Fig. 2). The same applies to their presentation of EPHOs, where EPHO 2 monitoring, however, appears to be a comparatively weak field (Fig. 2).

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Figure 4.21.8.1.Strength of competences and Essential Public Health Operation (EPHO) skills offered at three selected schools of public health in Poland, 2014 Low participation in lifelong learning continues to hinder employability of adults, especially older workers. In this respect, the key challenge is adjusting skills supply to skills demand. Adult participation in lifelong learning remains particularly low, especially among those aged 55 - 64 (0.8 % of the population). Moreover, the results of the OECD Adult Skills Survey show an urgent need to improve the skills of older adults in numeracy, literacy and particularly in problem-solving in technology-rich environments. Participation in lifelong learning tends to be low among those with a lower level of education, as well as those in the agricultural and industry sectors. In the continuing education the development shows how the attitude to professionalism and developing national standards has been growing over the past decade, and still remains an important concern for the future. It also shows the direction that Poland is taking in striving to achieve the most up to date standards and innovative methods of teaching, especially related to vocational training, which is also demonstrated in the trend for promoting and developing e-learning and digital learning resources and techniques.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.21 Portugal

4.21.1 Educational System

Stages of the education system

The Portuguese education system is divided in pre-school education (until the start of basic education), basic education (6 to 15 years old) and secondary education (15 to 18 years old). Pre-school education covers children from 3 years up to the age of compulsory schooling. This education is an optional cycle for children from 3 to 5 year-olds. In 2009, the Government established the universality of pre-primary education for children over 5 years old (Law no. 85/2009, 27 th August). From the school year of 2016/17 on the universality of pre-primary education will be extended to 4 years old children (Law no. 65/2015, 3rd July), and the government has declared the intention of extending its universality to all the 3 years old children until the end of 2019. There is a public and a private network of pre-school education institutions. Basic education lasts for nine years and is divided into three sequential cycles. Each cycle should complete and build up on the previous one, within a global perspective:

 Primary education o The first cycle corresponds to the first four years of schooling

o The second cycle corresponds to the next two years

 Lower secondary education

o The third cycle lasts for three years

In basic education besides general basic education pupils may attend specialized artistic courses in the areas of music and dance. Basic education can also be concluded and certified through different paths adapted to the profile and specific characteristics of the students, such as:

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Education and Training Courses:are an opportunity to conclude compulsory schooling via a flexible path adjusted to the interests of each individual, either to pursue studies or become qualified for the labour market.

 Alternative Curricular Pathways:are an exceptional measure (created in 2006) to be used when students show no progress in terms of school results, even after the adoption of measures promoting success, whose goals are school re-orientation.

 Integrated Education and Training Programme: encourages competencies for citizenship and social, community and solidarity activities, based on practical and differentiated work methodology, in order to promote education and vocational development.

Secondary education lasts for three years and corresponds to upper secondary education. It is organised into different forms according to different aims, either focusing on access to further studies or preparation for working life. The permeability between these two paths is guaranteed.It is currently compulsory for all students aged up to 18.

This level of education and training comprises different types of courses (Decree-law no. 139/2012, 5th June):

 Scientific-humanistic Courses: are focused on access to higher education.

 Professional and Vocational Courses: vocational courses which last two school years, are geared towards students’ professional qualification for working life, which also allow access to further studies.

 Specialised Artistic Courses (depending on the artistic area in question): are geared towards further study (music) or both entering the workplace and further studies (visual arts, audio-visual and dance);

 Courses with specific curriculum: offered by some private schools.

 Apprenticeship Courses are initial professional training courses aimed at young people that privilege their entry in the labour market while allows them to continue studying;

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Higher education is structured according to the Bologna principles to ensure solid scientific and cultural preparation, plus technical training that qualifies students for professional and cultural life, while developing their capability to innovate and apply critical analysis.

 Portuguese higher education system is a binary system that includes the university and the polytechnic systems. Universities are more geared towards scientific training, combining efforts and skills of teaching and research units and aims to guarantee a solid cultural and scientific preparation and to give technical training that allows students to exercise all kinds of cultural and professional activities, promoting the development of critical analysis, as well as conception and innovation skills, while Polytechnics are focused especially in vocational training and advanced technical training, is orientated towards applied investigation and development, focusing on the understanding and solution of problems aiming to provide a solid technical and cultural training at a high level and to develop the ability to innovate and to critically analyse and teach theoretical and practical scientific knowledge, with their applications in the exercise of professional activities.

 The Portuguese higher education system includes public higher education, made up of institutions belonging to the State and the foundations instituted by it, and private higher education, consisting of institutions belonging to private entities and cooperatives.

 In the Portuguese higher education system there is an institution geared to award all degrees and diplomas via distance learning (e-learning) called Universidade Aberta (Open University).

 Law No. 46/86, 14thOctober, amended by Laws 115/97, 19th September, 49/2005, 30th August and 85/2009, 27th August – the Comprehensive Law on the Education System – established, via the 2005 amendment, the adoption of the model of three cycles leading to three types of degree – Licenciatura (1st Cycle) Mestrado (2nd Cycle) and Doutoramento (3rd Cycle). o Licenciatura (1st Cycle): The Licenciado degree is awarded at Universities and Polytechnics.In University Education, the study cycle leading to a Licenciado degree boasts 180 to 240 credits and normally lasts between six and eight semesters. In Polytechnic Education, this cycle of studies has 180 credits and normally lasts six semesters or, exceptionally, when it is mandatory to grant access to a specific professional activity, 240 credits and

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

a time span of up to seven or eight semesters.In Polytechnic Education the study cycle that leads to a Licenciado degree should value essentialy the training aimed at the practice of a professional activity. o Mestrado (2nd Cycle):The Master’s degree is awarded by Universities and Polytechnics. The degree of Mestre is conferred in a specific area that may, when necessary, be unfolded in areas of specialization. The study cycle leading to a Master’s degree includes between 90 to 120 ECTS and normally lasts between three and four semesters, or exceptionally, two semesters that include 60 ECTS, following a stable and internationally consolidated practice. In University Education, the cycle of studies leading to a Mestrado degree must ensure that the student acquires an academic specialisation using research activity, innovation or deepening of professional competences. In Polytechnic Education, the cycle of studies leading to a Mestrado degree must ensure predominantly that the student purchase a professional specialisation. o Mestrados Integrados (Programmes outside the Bachelor and Master Structure):In University Education, it is possible to award a Master's degree after an integrated study cycle, usually called an Integrated Masters (Mestrados Integrados).The Integrated Masters consists of between 300 and 360 credits and normally lasts between 10 and 12 semesters, and can only be awarded when, for access to a given profession, that period over 8 semesters is established by legal norms or the result of a stable and consolidated practice in the European Union. o Doutoramento (3rd Cycle):The Doutor degree (3rd cycle) is awarded only by Universities and University Institutes.Although it is not defined the length of this study cycle, it is frequent to have six to eight semesters duration.The Doutor degree is conferred in a given field of knowledge or in one of its expertise subjects. Adult education and training provision varies and is geared towards specific aims and target groups:

Recognition, Validation and Certification of Skills: Processes in the Qualifica Centres involving the recognition of academic and vocational competences acquired by adults and that provide academic and/or vocational certification;

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Basic Competences Training Programme: Designed for adults to acquire basic reading, writing, maths skills and information and communication technologies competencies (ICT);

Adult Education and Training Courses: These courses aim to boost adult qualifications via dual certification;

Modular Training: Permit the conclusion of basic or secondary education and the acquisition of academic and vocational competences, in order to return to or progress in the labour market;

Technological Specialization Courses: These courses are designed to respond to socio- economic needs for middle level staff and provide an alternative for improving young people’s qualification and retraining of the working population;

Secondary Education Completion Paths: Aimed at those who attended but did not courses whose syllabuses no longer exist or will soon disappear;

Recurrent education: Designed for adults who have not completed their primary or secondary education at the usual age;

Portuguese for Speakers of Other Languages: Designed to meet the legal requirement of knowledge of Portuguese language to acquire Portuguese nationality, permanent or long- term residence, as well as to promote proficiency in reading, writing and speaking.

Within the context of adult education and training, the Qualifica Programme was designed for adults whose objective is to improve adult education and training, improving the population’s qualifications and individuals’ employability. The Qualifica Program is based on a qualification strategy that involves educational and training solutions, as well as a range of tools that promote adult qualification and an extensive network of providers.

4.21.2 Public Health Education and Educational Institutions

Studies in the field of Public Health in Portugal: Bachelor:

 Bachelor in Health Science o At the University of Lisbon

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o Programme duration: 3 years

 BSc in Clinical Analysis and Public Health o At the Fernando Pessoa University-School of Health o Programme duration: 7 semesters

 BSc in Enviromental Health o Polytechnic Institure of Coimbra-School of Health Technology o Programme duration: 4 years

 Health Science o At the Higher Institute of Health Sciences Egaz Moniz o Programme duration: 3 years

 Occupational and Health Safety

o At the Polytechnic Institute of Oporto-School of Technology and Mannagment of Felgueiras o Programme duration: 3 years

 Occupational Health and Safety o At the Lusofona University o Programme duration: 3 years

 Enviromental Health o At the Polytechnic Institute of Lisbon-School of Health Technology o Programme duration: 4 years

 Environmental Health o At the Polytechnic Institute of Oporo-School of Health Technology o Programme duration: 4 years Master:

 MSc Public Health

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o At the University of Porto o Programme duration: 2 years

 Master Program in Health Science o At the University of Minho o Programme duration: 2 years (full time)

 Master Programm in Public Health and Development

o At the Institute of Hygiene and Tropical Medicine (IHMT)

 Master in Epidemiology o At the University of Lisbon

 Master in Exercise, Health and Well-being for Special Groups o At the University of Coimbra o Programme duration: 2 years

 MSc Epidemiology o At the Instituto de Saúde Pública da Universidade do Porto (ISPUP) o Programme duration: 2 years

 MSc Public Health o At the Instituto de Saúde Pública da Universidade do Porto (ISPUP) o Programme duration: 2 years

 MSc Health Education

o At the Instituto de Saúde Pública da Universidade do Porto (ISPUP) o Programme duration: 2 years

 MSc Health Education

o At the University of Porto o Programme duration: 2 years

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 MS Environment, Health and Safety o At the University of the Azores-Ponta Delgada

 Occupational Health

o At the University of Coimbra-Faculty of Medicine

 Epidemiology o At the Nova University of Lisbon-National School of Public Health

 Public Health o At the Nova University of Lisbon-National School of Public Health

 Health Promotion

o At the Nova University of Lisbon-National School of Public Health

 Health Sciences o At the University of Minho

 Public Health o At the University of Oporto-Faculty of Medicine

 Education for Health o At the University of Oporto-Faculty of Medicine

 Health and Safety

o At the Poloytechnic Institute of Beja-School of Technolog and Management

 Education for Health o At the Polytechnic Insitute of Coimbra-School of Education

 Safety & Health at Work

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o At the University of Algarve-Istitute of Engineering

 Analysis and Control of Environmental Health Risks o At the Polytechnic Institute of Lisbon-Institute of Engineering

 Health and Safety o At the Institute of Setubal-School of Techology

 Health Promotion and Education o At the Viana do Castelo-School of Education

 Occupational Health and Safety o At the Higher Institute of Information and Administration Studies

 Safety & Health at Work Management

o At the Higher Institute of Education and Sciences

 Health and Community Intervention o At the Higher Institute of Intercultural and Transdisciplinary Studies of Viseu

 Management of Health and Safety at Work o At the Polytechnic Institute of Management and Technology – Higher School of Technology

 Communty Health Nursing

o At the Higher School of Nursing of Oporto

 Public Health Nursing o At the Polytechnic Institute of Braganca – Bragance School of Health

 Safety & Health at Work Management o At the University of Algarve- School of Health

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Community Health Nursing o At the Polytechnic Institute of Guarda-Guarda School of Health

 Family Health Nursing

o At the Polytechnic Institute of Leiria-School of Health

 Community Health Nursing o At the Polytechnic Institute of Santarem-School of Health

 Community Nursing o At the Polytechnic Institute of Viana do Castelo- School of Health

 Community Heath Nursing

o At the University of Traas-os-Montes and Alto Douro School of Nursing

 Community Health Nursing o At the Polytechinic Institute of Viseu – Health School

 Education for Health o At the Polytechnic Institute of Coimbra-School of Health Technology

 Occupational Health and Safety o At the polytechnic Institute of Coimbra-School of Health Technology

 Health and Safety

o At the Polytechnic Institute of Lisbon- School of Health Technology

 Health, Work and Environment o At the Polytechnic Institute of Lisbon-School of Health Technology

 Analysis and Control of Environmental Health Risks

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o At the Polytechnic Institute of Lisbon-School of Health Technoogy

 Hygiene and Safety in Organizations o At the Polytechnic Institute of Oporto-School of Health Technologies

PhD:

 PhD in Health Science o At the University of Minho.

 PhD in Tropical Diseases and Global Health o At the Institute of Hygiene and Tropical Medicine (IHMT)

 PhD in Human Genetics and Infections Diseases o At the Institute of Hygiene and Tropical Medicine (IHMT)

 PhD in International Health o At the Institute of Hygiene and Tropical Medicine (IHMT)

 PhD in Global Public Health o The programme is organized by a consortium of Four Schools: Lisbon NOVA University (National School of Public Health-ENSP, Nova Medical School- FCM, Institute of Hygiene and Tropical Medicine-IHMT) and University of Porto (Faculty of Medicine-FMUP, Istitute of Public Health-ISPUP)

 PhD in Public Health

o National School of Public Health-ENSP

 PhD in Dynamic of Health and Welfare (DHW) o National School of Public Health-ENSP

 PhD in Health Sciences o At the University of Coimbra

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 PhD in Public Health o At the Instituto de Saúde Pública da Universidade do Porto (ISPUP)

 PhD in EnviHealth&Co (Enviromental Health)

o At the Instituto de Saúde Pública da Universidade do Porto (ISPUP)

 PhD in Occupational Safety and Health o At the University of Porto

 Advanced Studies in Public Health (PhD) o At the University of Porto

 PhD in Clinical and Health Services Research

o At the University of Porto

 PhD in Public Health o At the University of Porto

 PhD in Ecology and Environmental Health o Fernando Pessoa University

 PhD in Occupational Safety and Health o University of Oporto-Faculty of Medicine

 PhD in Occupational Safety and Health

o Institute of Biomedical Sciences Abel Salazar

 PhD in Public Health o University of Oporto-Faculty of Medicine

 PhD in Occupational Safety and Health

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

o University of Oporto – Faculty of Pharmacy

 PhD in Occupational Safety and Health o University of Oporto – Faculty of Sciences

 PhD in Public Health o Nova University of Lisbon-National School of Public Health

 PhD in Dynamics of Health and Socila Protection: an approach to Social Sciences o Nova University of Lisbon-National School of Public Health

 PhD in International Health o Nova University of Lisbon-Institute of Hygiene and Tropical Medicine

 PhD in Human Genetics and Infectious Dideases

o Nova University of Lisbon- Institute of Hygiene and Tropical Medicine

 PhD in Tropical Diseases and Global Health o Nova University of Lisbon-Institute of Hygiene and Tropical Medicine

 PhD in Human Genetics and Infectious Diseases o Nova University of Lisbon-Nova Medical School

 PhD in Dynamics of Health and Social Protection: an approach to Social Sciences o Evora-Institute for Research and Advanced Training

 PhD in Health Sciecnes o University of Coimbra- Faculty of Medicine

 PhD in Global Public Health

o University of Oporto-Faculty of Medicine

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 PhD in Global Public Health o Nova University of Lisbon – National School of Public Health

 PhD in Global Public Health

o Nova University of Lisbon-Institute of Hygiene and Tropical Medicine

 PhD in Global Public Health o Nova University of Lisbon- Nova Medical School

4.21.3 Expenditure and Economics in Public Health

The Ministry of Health is responsible for developing health policy as well as managing the NHS. Five regional health administrations are in charge of implementing the national health policy objectives, developingguidelines and protocols and supervising helth care delivery.

Decentralization effords have aimed at shifting financial and management responsibility to the regional level. In practice, however, the autonomy of regional health administrations over budget setting and spending has been limited to primary care.However, data on health expenditure by health sector, for example, primary care, inpatient care and dental care, are not available. The Ministy of Finance sets the annual NHS budget based on historical spending and plans put foreard by the Ministry of Health. The Ministry of Health allocates a budget to each regional healthadministration for the provision of primary health care to a geographically defined population. Primary health care centres are financed by the regional health administrations and do not have financial or administrative autonomy, while public hospitals are financed through case mix-adjusted global budgets drawn up by the Ministry of Health. Health resources are unevenly distributed between the regions. However, in recent yers hospitals in the rural and inland areas have benefited from a programme of additional investment. Also, since 1997, a growing proportion of the budget is based on diagnosis-related groups as well as on unadjusted outpatient activity.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

In recent years The growth in total health expenditure was more pronounced in public health expenditure, which steadily increased its share of expenses.

It appears that Portugal has not contained health expenditure growth as successfully as other southern European countries and, Portugal now spends more than both Italy and Spain in terms of proportion of GDP.

One plausible explanation lies in the country’s political reluctance to impose cost-control measures after it was assumed that investment was needed in order to build up new facilities and to promote the expansion of NHS coverage.

4.21.4 Challenges and Future Perspectives

Public health services in Portugal include the surveillance of health status and identification of its determinants, health promotion and disease prevention at community level, and health impact assessment. The organization of public health services at national level is the responsibility of the DGH. The DGH is in charge of the establishment of programmes, definition of strategies and approval of national plans. One objective of the National Health Plan is to strengthen public health at both regional and local levels through the provision of epidemiological expertise and leadership functions in health promotion. At regional and local levels the main entities involved in the delivery of public health services are:

 local health authorities consisting of a public health team based in Groups of Primary Care centers (ACES);

 public health doctors and sanitary technical staff;

 RHAs, supporting public health units within ACES; and

 GPs/family doctors, responsible for health promotion as part of their work, including family planning, antenatal services and screening programmes.

Public health doctors are responsible for the epidemiological surveillance of the health status of the population and also for activities such as health promotion and disease surveillance. However, in many primary care centres these responsibilities are transferred to GPs, due to a shortage of public health doctors. Public health doctors’ responsibilities include:

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 surveillance and control of communicable disease;

 surveillance of water quality parameters;

 environmental health surveillance (with municipalities);

 ensuring compliance of local services (including health facilities) with health and safety standards;

 environmental inspections of workplaces and work conditions; and

 building safety and housing inspection (with municipalities).

In 2008, the creation of the ACES restructured the organization of primary care and public health.

Public health doctors currently have a low status within the NHS and thereare problems with recruitment. Their work up to now has been to act as health inspectors and occupational health officers, which was heavily bureaucratic and meant working under old directives. The aim of the latest policies set out in the National Health Plan is to link the development of local health systems with the new public health structures, giving public health doctors a broader remit in terms of the health of the population. By creating these new public health units, previously disparate resources will be brought together.

The regional public primary care centres play a big role in promotion and prevention, for example, by developing school health programmes and education towards healthier lifestyles.

This service responds to personal primary care needs through health promotion and disease prevention, as well as public health needs, while participating in partnerships with other services to improve the health status of certain groups and communities: it advises people on how to protect themselves from environmental risks, such as heat waves or cold snaps, or the existence of polluted air due to particles in suspension (e.g. a consequence of forest fires); it helps to prevent disease from spreading in epidemic situations, such as influenza or acute respiratory syndrome; and it promotes and encourages healthy behaviours (nutrition and family planning).

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Another useful means of distributing public health information to a vast proportion of the population in a straightforward manner is the development of Internet web sites dedicated to public health issues, such as those provided by the Ministry of Health and the DGH. The NHS is responsible for the National Vaccination Plan, which includes vaccines considered to be the most important for protecting population health. These vaccines can be altered from one year to the next in order to adapt the programme to the population’s needs, usually by combining new vaccines. People can be vaccinated in local primary care centres and vaccines that are part of this National Plan are free for Portuguese legal residents. Relatively high levels of vaccination are achieved in Portugal.

Since a great deal of the population’s time is spent at school, at work and in leisure locations, public health interventions require a multisectoral approach. To strengthen this approach, the Ministry of Health cooperates with other ministries, such as the Ministry of Labour and Social Solidarity (for workplaces), the Sports Secretary of State (for sports spaces), the Youth Secretary of State (for public leisure locations), the Ministry of Education (for primary and high schools) and the Ministry of Justice (for prisons). Portugal has the highest percentage among the EU15 countries of people living in absolute poverty, at 22% in 2002 (European Commission, 2002). Poverty is particularly prevalent in the southern region (Alentejo). Poorer and geographically isolated people have even greater problems in accessing health services, because there are fewer hospitals than primary care centres and they are concentrated in more populated/urban areas. To reduce inequalities in access to health care, the government has implemented policies aiming to reduce waiting times for surgery in addition to the dental voucher, focused on pregnant women, poor elderly and the youth. 4.22 Romania

4.22.1 Description of the Educational System, Structure and Management

Education in Romania is based on tuition-free system. There are 11 mandatory years of education. First there is a kindergarten, preparing for school years. Then there are 4 years in primary and 4 years in secondary school. High school starts in the 9th grade and generally takes four years to complete. Secondary education is highly centralized and

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

admission to high schools is determined by the performance in the nation-wide tests organized by the Ministry of Romanian Education and research.

In Romania, higher education is provided by Universities, institutes, study academies, schools of higher education and other similar establishments. These Higher education institutions can be state-owned or private. They are non-profit, apolitical in nature, and focused on the public interest. After the implementation of the new Education act, Romanian universities were divided to three tiers:

 Universities focusing on education (offering only Bachelor degree),

 Universities focusing on education and scientific research or education and art (offering Bachelor’s and Master’s programs)

 Universities with an advanced research and education focus (offering Bachelor’s, Master’s and PhD degrees). At University level, Romanian system recognises Bachelor’s programs, Master’s program, PhD programs.

The Bachelor studies (Undergraduate studies), with a length that varies according to the field25:

 6 semesters (3 years) for sciences, humanities, economic and social sciences, political sciences, etc.;

 8 semesters (4 years) for engineering, technique;

 12 semesters (6 years) for general medicine, dental medicine, veterinary medicine and architecture.

The master studies correspond, usually, to a number of credits between 90 and 120, a master semester corresponding to a number of 30 study credits. The total length of the 1st cycle (undergraduate studies) and 2nd cycle (master studies) has to correspond to at least 300 transferable study credits. The post-university programs offered by the Romanian educational system are:

25http://www.euroeducation.net/prof/romco.htm | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

a) Post-Ph.D. programs, with a minimum length of 1 year; b) Specialisation studies, with a length of 2 or more semesters;

c) Lifelong learning programs.

The post-university specialisation studies correspond to a minimum length of 2 semesters and a minimum number of 60 credits. The lifelong learning programs can also be organized according to ECTS.

4.22.2 Students Demographics, Legislation

To the best of our knowledge data about student structure and demograhpics are not available online. The specific legislation, regulating higher education in Romania is represented by three organic laws: the Law on Education (Law 84/1995), the Statute of teaching staff (Law 28/1997), with its further as well as the Law of accreditation of higher education institutions and recognition of diplomas (Law 88/1993), with theirs further modifications and supplements.

4.22.3 Public Health Educational Institutions

The most relevent public health education institution in Romania is Cluj School of Public Health (C-SPH). C-SPH is an innovative research focused program with full English educational track in public health – BA, MPH, PhD in Cluj, Romania. This is the only Public Health program taught completely in English in the entire Central and Eastern Europe. Cluj School of Public Health is formed from the Department of Public Health (educational wing) and the Center for Health Policy and Public Health (research wing), within the College of Political, Administrative and Communication Sciences of Babes-Bolyai University – the biggest and highest ranked university from Romania.The program brings an interdisciplinary approach on Public Health tackling five major fields: Health Policy and Management, Social and Behavioral Health, Epidemiology, Statistics, and Environmental Health. University of Medicine and Pharmacy Carol Davila of Bucharest wasestablished in 1857 under the name National School of Medicine and Pharmacy by French expatriate medic Carol Davila. Carol Davila University of Medicine and Pharmacy was the first medical school in Romania. In 1869 it became a department in the newly created University of Bucharest.The first doctoral degrees were granted in 1873.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

All others faculties in Romania orginize studies in general medicine, (and) dentistry, (and) pharmacy, such as: Faculty of Medicine and Pharmacy of the University of Oradea, Victor Babes University of Medicine and Pharmacy of Timisoara, Constanta Medical School (Ovidius Univrsity of Constanta), University of Medicine and Pharmacy Targu Mure, G.T Popa University of Medicine and Pharmacy Iasi, University of medicine Craiova, Faculty of Medicine, Pharmacy and Dental Medicine of Arad University.

4.22.4 University Programs in Public Health both, Undergraduate and Postgraduate

Table 4.23.4.1.The only University that provides studies in public health is Cluj School of Public Health.

Level School Description Undergraduate Bachelor in Health policy and Programs management Bachelor in Health administration Bachelor in Community and Behavioral Health Cluj School of Public Health Bachelor in Epidemiology Bachelor in Biostatistics Bachelor in Occupational and Environmental Health Bachelor in Health Promotion Graduate/ Master in Social & Behavioral Master Programs Health Master inEnvironmental Health

Cluj School of Public Health Master in Health Policy & Management Master in Biostatistics and Epidemiology PhD programs Doctor of Public health Cluj School of Public Health

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.22.5 Continuing Education, Life Long Learning

The National School of Public Health Management and Professional Development is a public institution that provides support for public health policies development and implementation by performing scientific research and providing postgraduate training and technical assistance in the field of public health and health services management.

4.22.6 Public Health Professionals Certification (Legislation)

Health professionals are registered with the relevant professional organization to which they apply to be accredited or reaccredited. In order to be reaccredited, health professionals must comply with continuing medical education (CME) requirements. Any citizen of an EU Member State, an EEA country or Switzerland, who has graduated from a medical university in their country of origin, is entitled to practise in Romania. Any citizen of a third country having permanent resident status in Romaniaand a diploma recognized by Romania or any EU Member State, or havingdocuments issued by any EU Member State that prove professional experience of at least three years in the medical field, is also entitled to practise. The Ministry of Health controls, the number of health professionals in the system26.

4.22.7 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

The most significant teachertraining programme in Romania is Intel Teach, that is intending to prepare teachers to use the ICT for setting up efficient learning situations.

Romania is the first country in Europe in terms of telemedicine. The national telemedicine network includes two command centres, at Floreasca Hospital in Bucharest and Clinical Emergency Hospital of Târgu Mureș and 56 hospitals in 19 counties. Thus, doctors at the two command centres provide medical support in real time to any of the hospitals in the country and pursue the patient's vital signs.

26 Cristian Vladescu, Silvia Gabriela Scîntee, Victor Olsavszky, Cristina Hernández-Quevedo, Anna Sagan, Romania Health system review, Health Systems in Transition, Vol. 18 No. 4 2016 (Europian observatory on helth system and policies- a partnership Hosted by WHO) | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.22.8 Expenditure and Economics 27

Table 4.23.8.1. 2009 2010 2011 2012 2013 2014 Government expenditure on 4.16% 3.46% 3.03% 2.94% n/a n/a education as % of GDP (%) Government expenditure on tertiary education as % of 1.18% 0.98% 0.84% 0.77% 0.72% n/a GDP (%) Government expenditure per tertiary student as % of GDP 21.83% 19.95% 19.37% 21.87% 23.13% n/a per capita (%)

The Ministry of Health is, among other things, in charge of monitoring and evaluation of population health, provision of public health education and health promotion, human resources policy and certain infrastructure investments. In last years, there is an increasing number of initiatives of local (or local branches of) international companies in Romania to fund health projects. These practices are further encouraged through legislation; for example, the Government Emergency Ordinance from March 2015 provides that at least 40% of donations made by state companies should be spent on health and education and no more than 20% on other domains. There are legislative proposals for introducing fiscal deductibility for any donations made by natural persons and for increasing the limit for fiscal deductibility for donations made by companies from 0.3% to 0.6% of turnover.28 4.23 Slovakia

4.23.1 Description of the Educational System, Structure and Management

Slovakia has complex multilevel educational system, as follows29.

27 Source for data in tables: UNESCO Institute for Statistics available at: http://databank.worldbank.org/data 28 Vlãdescu C, Scîntee SG, Olsavszky V, Hernández-Quevedo C, Sagan A. Romania: Health system review. Health Systems in Transition, 2016; 18(4):1–170. pp 91-92, available at: http://www.healthobservatory.eu 29http://www.slovak-republic.org/education/ | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

The primary and secondary schools system consists of primary schools, primary schools with kindergarten, apprenticeship training institutes, secondary vocational institutes, secondary high schools, secondary vocational schools and special schools. Kids 3 to 6 years old attend kindergartens which develops communication skills, thinking and interests and in general prepares kids for primary school. Primary education in Slovakia lasts for nine years and is compulsory. It is divided into two stages of for and five years (1st-4th grade – 5th-9th grade). Schools in Slovakia are State schools, owned by Church or private schools. Secondary schools are preparing students for professional occupations and for university study. There are a few types of secondary schools in Slovakia: Grammar schools, Specialized secondary schools, Conservatories, Vocational schools. Study at secondary school finishes with school leaving examination and students obtain „maturita“certificate. After obtaining the “maturita“ certificate, students can apply for higher education including University study. Study programs of Slovakianuniversities are organized on three levels:

 Bachelor degree (3-4 years),

 Master of Arts, Science, Engineering or Medical Doctor degree (4-6 years, including bachelor degree)

 Doctoral degree (3-4 years). The Higher Education Act divides the higher education institutions into:

 university-type: the primary orientation is at basic research and emphasis is laid on doctoral study programmes.

 professional higher education institutions30: provide the Bachelor’s study programmes only, and they are oriented particularly on the applied research.

As at 1st January 201131, there were 20 public higher education institutions, three state- owned higher education institutions, twelve private higher education institutions, and four foreign higher education institutions functioning in the Slovakia.

30http://www.euroeducation.net/prof/slovakco.htm 31http://www.euroeducation.net/prof/slovakco.htm | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.23.2 Students Demographics, Legislation

The study at the higher education institutions in the Slovak Republic is governed by the Act on higher education.

Information on the possibilities of studies abroad, scholarship student exchanges, and language courses abroad based on the international agreements and designed for students, PhD students, teachers, scholars and artists in the education sector can be obtained through the Slovak Academic Information Agency32. According to UNESCO’s statistics, more than 9,000 internationally mobile tertiary level students attend Slovak higher education institutions each year – more than half of which come from the Czech Republic, followed by Greece, with only a small amount of students from India.33

4.23.3 Public Health Educational Institutions

There are 5 universities offering public health education on bachelor, master and doctoral level. There are accredited universities of the Ministry of Education by Accreditation Committee of the Government of the Slovak Republic. The three levels of education are fully harmonized with the Bologna principles. The Accreditation Committee of the Government of the Slovak Republic describes very detailed aims of a public health education program including recommended study subjects. Universities add to additional, mostly clinical medicine or hygiene subjects to recommend study subjects leaving likely very little time for research at universities.

4.23.4 University Programs in Public Health both, Undergraduate and Postgraduate

Table 4.24.4.1. Level School Description Undergraduate St. Elizabeth University of Bachelor in Public Health Programs Health and Social Work in

32 Sources: The Ministry of Education, Science, Research and Sport of the Slovak Republic, https://www.minedu.sk/ and Study in Slovakia, http://office.studyin.sk/entering-slovakia/foreign-applicants.html 33 Sourse: Study in Europe, http://www.study-europe.net/countries/slovakia

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Bratislava Bachelor studies in Public Health Trnava University, Faculty Care, Social Work, Nursing and of Health Care and Social Laboratory Investigation Methods Work Bachelor studies in Social Work in Health Care Pavol Jozef Šafárik Bachelor in Public health University in Košice, Faculty of medcine Comenius University, The Bachelor in Public health Jessenius Faculty of Medicine in Martin Nursing (BSc) Constantine the Psihology (BSc) Philosopher University in Social Work (BSc) Nitra, Faculty of Social Social Services and Counselling Sciences and Health Care (BSc) Urgent Medical Care (BSc) Graduate/ Master of Public Health St. Elizabeth University of Master Programs Master of Public Health Health and Social Work in Administration Bratislava Master of Tropical Public Health MSc studies in Public Health Care, Social Work, Nursing and Trnava University, Faculty Laboratory Investigation Methods of Health Care and Social MSc studies in Management and Work Organisation of Social Welfare Services Pavol Jozef Šafárik Master in Public Health University in Košice, Faculty of medicine Comenius University, The Master in Public Health Jessenius Faculty of Medicine in Martin Constantine the Applied Social Work (MSc)

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Philosopher University in Social Services and Counselling Nitra, Faculty of Social (MSc) Sciences and Health Care PhD Programs St. Elizabeth University of Doctor of Public Health Health and Social Work in Bratislava Trnava University, Faculty PhD studies in Public Health Care, of Health Care and Social Social Work, Nursing and Work Laboratory Investigation Methods Comenius University, The Doctor of Public Health Jessenius Faculty of Medicine in Martin Constantine the Social Services and Counselling Philosopher University in (PhD) Nitra, Faculty of Social Sciences and Health Care

4.23.5 Continuing Education, Life Long Learning

The main goal of the Strategy of Lifelong Learning and Lifelong Guidance of Slovak republic (passed by the Government of the Slovak republic in April 2007) is the completion of the system of lifelong learning and the system of lifelong guidance in such a way that the system would make the access to repeated and flexible obtaining of new qualifications for the citizens easier through good-quality education obtained apart from formal also in non- formal system of education and in the system of informal learning with the assistance of complex counselling and guidance services during the entire life of the man and hence to help people to sustain highest possible employment level as well as to increase the participation of the population in lifelong learning.

4.23.6 Public Health Professionals Certification (Legislation)

The Act of health care providers establishes the process for recognition of education certificates. Diplomas, school reports and other educational documents issued by foreign schools or other authorized authorities under the laws of the respective states are recognized in Slovakia by the respective authority under the Act of recognition on professional qualifications.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Specialist diploma issued by foreign schools or other authorize authorities are recognized by te Ministry of education and recognition process is established in the Act of health care providers.34

4.23.7 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

In the current educational trends, the Virtual Learning Environment (VLE) is gaining an important position in Slovakia. It is the electronic environment, in which teaching is organized and managed in certain and goal-directed ways. MEFANET is unique. It is an invaluable active sharing network involving all the medical teaching institutions from 2 separate countries – Slovac Republic and Czech Republic.

4.23.8 Expenditure and Economics 35

Table 4.24.8.1. 2009 2010 2011 2012 2013 2014 Government expenditure on 4.02% 4.13% 3.97% 3.92% 4.11% n/a education as % of GDP (%) Government expenditure on tertiary education as % of GDP 0.80% 0.81% 0.93% 0.94% 0.97% n/a (%) Government expenditure per tertiary student as % of GDP 18.24% 18.62% 22.15% 23.00% 25.10% n/a per capita (%)

The management and supervision of health education and the curriculum are shared between the Ministry of Health and the Ministry of Education, the latter being responsible for financing. The Ministry of Health coordinates health research in schools and the

34 Zuzana Chudackova, Iva Hulmanova, Accessibillity to Health Care in Slovakia, Journal of the International Institute for Law and Medicine, 2015, pg. 43-60. 35 Source for data in tables: UNESCO Institute for Statistics available at: http://databank.worldbank.org/data | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Academy of Sciences. This shared competence often leads to confusion. In addition, the Ministry of Finance has a strong influence on the health budget development process.36

The Strategic Framework for Health 2014–30 tackles the planning of human resources in Slovakia. Firstly, it addresses the ageing workforce, and should reduce the average age of general practitioners from currently 54 to 40 years by 2030. Key to achieving this goal is a newly established Residency program which aims to (1) reduce the average age of general practitioners and pediatricians, (2) improve education in general medicine for adults, children and adolescents, and (3) improve the quality and accessibility of health care in primary care. By 2012, 481 doctors and 864 nurses (including midwives) had benefited from the scheme, which cost 9.3 million EUR and was mostly financed by the European Social Fund (ESF, 2016). Other ESF-funded projects have aimed to improve health professionals’ clinical and managerial skills. From 2008 to 2012 the ESF and Ministry of Health invested over 40 million EUR towards the education and training of Slovak health professionals. Similar projects are currently in place for general practitioners. 4.24 Slovenia

In Slovenia, primary and lower secondary education are unified and last for 8 years. A new system is being gradually implemented whereby this level will last for 9 years (3 three-year cycles). There are three types of secondary schools with: a) vocational education programmes (lasting for two-and-a-half or three years, the latter offering the possibility to continue in a two-year upgrade programme or lead directly to the labour market); b) technical education programmes (four-year programmes in different areas); and c) general education programmes (classical gimnazija, technical gimnazija, economic gimnazija, art gimnazija and programmes leading to the International Baccalaureate). In the two bilingual regions, primary and secondary education for the Italian and Hungarian ethnic minorities are offered in Italian, Hungarian and Slovenian. Higher education is regulated by the Higher Education Act (1993, amended 1999, 2001, 2003, and 2004). The most important features introduced by the new legislation are: the new role of the university (change from an association of independent faculties to an integrated university) and the creation of single higher education institutions, the separation of some large faculties into several smaller ones, changes in the structure of the

36Smatana M, Pažitný P, Kandilaki D, Laktišová M, Sedláková D, Palušková M, van Ginneken E, Spranger A (2016). Slovakia: Health system review. Health Systems in Transition, 2016; 18(6):1–210, pp.27, available at: http://www.healthobservatory.eu | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

higher education system, the implementation of the Diploma Supplement and the gradual implementation of a three-cycle higher education system according to the Bologna Declaration by 2016. Public higher education is free of charge for native full-time students and for students from EU countries. Part-time students and post-graduate students pay tuition fees. Today, higher education has certain features of a binary structure. Degree study programmes are classified into three cycles as follows: first cycle (academic study programmes and professionally-oriented study programmes), second cycle (study programmes leading to Magisterij), and third cycle (study programmes leading to the Doktorat znanosti). First cycle study programmes are at the undergraduate level, second and third cycle study programmes are at graduate level. Higher education institutions comprise universities, faculties, art academies or professional colleges. Slovenia has 4 universities with 37 faculties, 3 art academies or professional colleges, and 10 single higher education institutions (Samostojni visokošolski zavodi) established as private institutions. Higher education institutions are autonomous in managing their internal organization and operations (considering their statutes and the legal requirements), selecting and electing the faculty, electing the internal bodies: rectors, senates, administrative boards and student councils, deans and academic assemblies. In addition to teaching, higher education institutions also conduct research and offer artistic activities. High school graduates can enter one of the institutions of tertiary education (university, faculty art academy or professional college). Currently there are three public universities in Slovenia: the University of Ljubljana, the University of Maribor and the University of Primorska. Other institutions of tertiary education in Slovenia include the University of Nova Gorica, the Euro-Mediterranean University of Slovenia and others. According to the ARWU rating, the University of Ljubljana is among the top 500 universities in the world. Basic education leading to a university degree conferring the title of MedicalDoctor takes six years. After graduation from the Medical Faculty there is anobligatory 6-month internship, which has then traditionally been extended intoan obligatory semi-structured 18-month postgraduate training programme called“secundariate”. Since January 2007 the “secundariate” has been abolished andyoung physicians enter the postgraduate training for medical specialists directlyafter their internship. Since 2000, the entire area of postgraduate specialist training has beenreformed. Some new specialties have been introduced, while the older corecurricula have been thoroughly revised and harmonized according to theguidelines of the UEMS (Union Européenne des Médecins Specialisés) for eachrespective specialty. This process was completed for the majority of medicalspecialties in spring 2002. | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Competency for preparing and implementing the programme of medicalspecializations was given to the Medical Chamber. The Chamber prepares listsof qualified tutors, health care providers and institutions with which trainingcan take place. Alongside this, there are also coordinators for each of thespecialties who supervise both the tutors and the registered training institutions.During the course of the training, tutors should monitor the candidates. Theexamination commission at the Medical Chamber performs the final exam andissues certificates. Twice per year there are tenders, as part of which specialisttraining posts are offered to junior doctors. Posts are offered by specialty andby region. Candidates may apply for different specialties, but can eventuallyonly qualify for one post. Ranking is based on previous work, references andpoints obtained, based on additional activities (research, recommendation bytutors, additional courses, and so on).

Pre-training requirements. All residents must be graduates of general or dental medicine – the studies of both last 6 years. After the graduation there is a 6-month (for general medicine) or 12-month (for dental medicine) obligatory internship, which consists of rotating through different specialties and is followed by a professional exam. Future residents must apply for the specialization through a public tender, which is published twice a year by the Medical Chamber of Slovenia. The selection of the resident to the specialization is determined by an interview, based on a number of criteria (interview score, grade average, letters of recommendation, participation in additional trainings or publications during and post-graduation, etc.) The curriculum consists of 2 phases:

1st: introduction to basic core public health skills (2 years)

2nd: in-depth assessment of specific public health areas and a specialty thesis (2 years). 4.25 Spain

Education in Spain is regulated by the Ley Orgánica para la Mejora de la Calidad Educativa (LOMCE, Organic Law of Education) that expands upon Article 27 of the Spanish Constitution of 1978. Education is compulsory and free for all children aged between 6 and 16 years, and is supported by the national government together with the governments of each of the country's 17 autonomous communities.

Schooling in Spain is state funded and is compulsory between the ages of six years and sixteen, given that no courses are repeated. Although non-university education in state-

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

funded schools is free in Spain, parents must pay for books, materials, and sometimes uniforms for their children. Once the required schooling is finished, a student can then opt to continue on to high school (bachillerato) or move on to a vocational school. Only those who finish high school can be admitted to a university.

There are three categories of Spanish schools in the Spanish education system: public schools (colegios públicos), state-funded private schools (colegios concertados) and private schools (colegios privados). Since some private schools are publically funded the line between public and private is blurred. The Spanish high school Baccalaureate is non-compulsory free education that consists of one cycle in two academic years for students age 16-18. The Spanish Baccalaureate consists of a series of required common classes, elective classes and specialization classes known as “modalidades”, or concentration in a certain discipline. A student must specialize in one of the offered disciplines and if the students plan to continue on to university, certain concentrations may be required in order to be admitted into certain university programs. Required classes of the Spanish Baccalaureate include 2 years of both Castilian language and literature (or the co-official language) and foreign language, and 1 year of philosophy and civic responsibility, physical education, contemporary science, history of philosophy and the history of Spain. Elective courses may include: a second foreign language, information technology, dance, art, theater, music, or other classes depending on the school. The specialization part of the Spanish high school Baccalaureate requires a student choose one of 4 concentrations for which they will be required to take 3-4 classes a year. Each concentration has obligatory classes and other classes from which to choose from. The National School of Public Health of Spain (Escuela Nacional de Sanidad, or ENS, in Spanish) is a public research institution in Madrid in the field of Public Health and Health administration. Founded in 1924 with the support of the League of Nations and the Rockefeller institution, the National School of Public Health is the oldest organization in Spain serving in the field of Public Health research and education. Nowadays, it is part of the Carlos III Health Institute. According to the QS World University Rankings, five Spanish medical schools have been successfully ranked in the global top 300 for Life Sciences & Medicine published by the University of Shanghai.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Before enrolment medical studies somebody need to participate 2 years of Biological Sciences (Chemistry, Mathematics, Physics, and Statistics) and General Knowledge (such as Grammar, Foreign languages, Literature, Philosophy, History) a Selection Test is required. Once the test is done, candidate is satisfied with the condition accepted into University.

There are public and private universities to study Medicine in Spain. Students need to do a test of Biological Sciences, a test of level of English and a psychological test. Every test has a mark. All marks are averaged for a final mark and the best marks are accepted to be enrolled. Medical studies last six years, 3 years of basic sciences + pharmacology, 3 years of clinical training. Public health is one of the medical specialization in Spain.

The Healthcare Online programme is part of the Avanza Plan, an initiative launched by the Spanish government to accelerate Spain's integration into the Information Society, to increase productivity, strengthen the Information and Communication Technologies (ICT) sector, promote R&D and consolidate modern and interoperable public services based on ICT use. The Online Healthcare is also part of the Ministry of Health and Social Policy's strategy to “use ICT to improve citizen’s healthcare” as described in the Quality Plan for the National Health System. The programme is the result of the collaboration in the area of eHealth between the Central Government and the Autonomous Regions which seeks to progress the work already done by the Ministry of Health and Social Policy and the Regional Health Services in improvingthe quality of service that citizens receive.

The Ministry of Industry, Tourism and Trade, the Ministry of Health and Social Policy and all the Regional Health Services have been working together on the development of the Online Healthcare programme, in the context of the Quality Plan for the National Health System. The Instituto de Salud Carlos III (Institute of Health Carlos III, ISCIII) is the main Public Research Entity funding, managing and carrying out biomedical research in Spain. The Institute has been conducting research and providing key services in the life and health sciences for over 20 years. It is also the body responsible for managing Spain's Health

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Research and Development Strategy within the framework of the National R+D+I Plan. Reports directly to the Ministry of Economy and Competitiveness (Royal Decree 345/2012) and in operational terms to both this Ministry and to the Ministry of Health, Social Services and Equality (Royal Decree 200/2012), has as its main mission to support the development of scientific knowledge in the health sciences and to contribute to innovation in healthcare and the prevention of disease. Putting patients and the public at the heart of all its activities and objectives, the Institute promotes and coordinates biomedical research and provides scientific and technical services of the highest quality in partnership with all the organizations forming part of the Spanish System of Science, Technology and Innovation. Its basic objectives are:

 The generation of knowledge in health sciences.

 To have a positive impact on public health.

 The generation of wealth via innovation and the creation of different business initiatives.

The ISCIII is involved in the provision of basic and advanced training for health professionals in order to meet the health requirements of today's society. It provides training, advice and research into the causes of occupational diseases and illnesses related to the workplace and carries out general training in its centers for public health professionals through grants and placements. Training in the ISCIII schools is organized through postgraduate courses (Master's degrees and university diplomas) and specialist training of medical interns in the fields of public health, preventive medicine and occupational medicine. 4.26 Sweden

4.26.1 The Educational System, Structure and Management, Students Demographics, Legislation

School education:

The Swedish state school system comprises compulsory school and various types of voluntary schooling. Compulsory school includes nine years of compulsory basic school, school for the Saami people of Northern Sweden, special school and compulsory school for

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

the mentally handicapped. Post-compulsory education is offered through 17 National Programmes providing qualifications that allow students to go on to higher education. Some of these programmes also include industrial work placements. The National Programmes of upper secondary education are offered at Gymnasia. Tuition is free.

Outside the upper secondary school system there are folk high schools which provide state- supported adult education lasting between one and three years of studies. There are no formal examinations.

Post-secondary studies include advanced vocational training which is intended to meet the labour market's needs for the skills required for modern production of goods and services. About one-third of the course period takes place at the workplace. As from January 2002, this form of training is a permanent part of the Swedish educational system but does not belong to the higher education sector. Admission is based on three-year upper secondary education or corresponding proficiency. The training is normally intended to correspond to two years of study and leads to a Certificate of Advanced Vocational Training.

Higher education: The Swedish system includes not only traditional university studies, but also Teacher Training, Health Care Training, Technical Training, etc. It is the responsibility of: the central government, regional authorities and private interests. All higher education institutions fall under the jurisdiction of the Ministry of Education except for the University of Agricultural Sciences (Ministry of Agriculture). Higher education is divided into undergraduate studies (courses combined towards a first degree) and postgraduate studies and research. Sweden has adopted the Bologna system in line with other European countries. The qualifications you earn at Stockholm University will be easily understandable throughout Europe and the world. The national system of credits used in Sweden (''högskolepoäng'') is equivalent to credits measured in ECTS. All courses and programmes are divided into three cycles. There are three categories of qualifications: general degrees, degrees in fine, applied and performing arts and professional degrees. Each degree is placed within one of the three cycles.

General degrees: First cycle

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Higher Education Diploma 120 credits Bachelor's Degree 180 credits Second cycle Master's Degree (1 year) 60 credits Master's Degree (2 years) 120 credits Third cycle Licentiate Degree 120 credits Doctoral/PhD Degree 240 credits

4.26.2 Public Health Educational Institutions

There are seven universities authorized to educate physicians in Sweden: in Lund, Gothenburg, Linkoping, Stockholm (Karolinska Institute), Uppsala, Umeå and Örebro. Approximately 1600 students were admitted to school in 2011. Nurses are educated at approximately 30 universities, university colleges and independent programme providers located throughout the country. Approximately 5000 students are admitted to the nursing programme every year. Universities which offer studies in the field of Public Health are: Stockholm, Uppsala, Umeå, Lund, Gothenburg and the Karolinska Institute. Out of those the Umeå University, Karolinska Institute and Lund University build a partnership, the Swedish Research School for Global Health.

4.26.3 University Programs in Public Health both Undergraduate and Postgraduate

Master´s Programmes:

 Master's Programme in Public Health Sciences - specialization Public Health Epidemiology Programme duration: 2 years (120 ECTS credits) University: Karolinska Institutet

 Master's Programme in Population Health: Societal and Individual Perspectives Programme duration: 2 years (120 ECTS credits) University: Stockholm University

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Master's Programme in Medical Science in International Health Programme duration: 2 years (120 ECTS credits) University: Uppsala University

 Master's Programme in Public Health Programme duration: 2 years (120 ECTS credits) University: Umeå University

 Master's Programme in Public Health (one-year) Programme duration: 1 year (60 ECTS credits) University: Umeå University

 Master's Programme in Public Health with a Specialization in Health Economics Programme duration: 2 years (120 ECTS credits) University: Umeå University

 Master's Programme in Public Health Programme duration: 2 years (120 ECTS credits) University: Lund University

 Master's Programme in Economics – public Economics with Health and Labour Economics Programme duration: 2 years (120 ECTS credits) University: Lund University

 Master's Programme in Public Health Science with Health Economics Programme duration: 2 years (120 ECTS credits) University: University of Gothenburg

 Master's Programme in Global Health Programme duration: 2 years (120 ECTS credits) University: University of Gothenburg

The Swedish Research School for Global Health conducts a variety of public health courses at the various locations of the participating universities. Some of the courses can be accounted for ECTS, also they include workshops and seminars.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.26.4 Continuing Education, Life Long Learning

Within the Swedish educational system, extensive examples of lifelong learning policy have been implemented. They may be summarised as follows:

 Equal access for all and the scope for diversity is a fundamental guiding principle of education policy;

 Within the upper secondary education system, students choose between 16 national programmes, of which 14 are vocationally oriented. The remaining two concentrate on preparing students for university studies;

 Students with difficulties after compulsory education pursue personalised programmes such as the IV programme and the individual study plan;

 Adult immigrants are integrated after a course in Swedish into school for adults;

 Within the university framework, there is an interesting 24:4 rule, that is students should be above 24 years old in the academic year; and have been employed, at least half time for four years in order to be eligible to apply;

 The vouchers system gives students the freedom to choose their school, and schools have incentives to attract students;

 The AEI initiatives and KY programmes consist of new forms of training and they both aim at setting up new teaching methods, new educational providers and involve more actively employers and teaching providers. In particular, the KY programmes are other examples of how the lifewide perspective of learning takes place in Swedish VET where the formal learning acquired at school is combined with both non-formal and informal learning at the workplace;

 As part of the knowledge week, municipalities disseminate adult education information. The different actors and educational providers for the AEI have been organised under the supervision of a coordinator in each municipality. Such a network has created possibilities for the educational ministry to take action when proposing and supporting a knowledge week.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Swedish policy is actively supporting a lifelong learning perspective for VET. Below are some examples of such policy:

 Increased use of ICT. A high level of computer literacy exists at both youth and adult levels – this is due to tax breaks for the use of computers at home and following the introduction of a new national time schedule in schools, there is no special allocation for computer science as a subject – instead computers are used as a tool in all subjects;

 Increased possibilities of financing further VET for individuals. Companies mainly finance adult education, but a great deal of subsidies is granted by State study assistance on an individual basis. An individual study account may also be set up;

 Increased possibilities for social partners to cooperate in arranging and implementing VET. Social partners are involved in adult learning by means of motivation visits to those reluctant to participate in further education. As in other Scandinavian countries, lifelong learning is very well developed in Sweden, and contributes to making the system inclusive. The level of participation in formal and non- formal education –the latter referring to open or distance learning, private lessons, workshops, etc. – among 25-64 year-olds is 66%, the highest across OECD countries alongside Denmark and Finland. Generally, most people engaged in lifelong learning are employed and this is also the case in Sweden with 71% of those in employment participating in formal and/or non-formal education. Still, the participation rate of inactive people – i.e. people not looking for a job – is 36% in Sweden, the highest rate of all OECD countries. To this extent lifelong learning can be an effective way to reintegrate the labour market. The willingness to take part in learning activities is also well developed among the adult population. Thus one in three 25-64 year-olds in Sweden report wanting to participate in education, while one in four neither participate nor want to.

4.26.5 Public Health Professionals Certification (Legislation)

All health care personnel come under the supervision of the National Board of Health and Welfare. The Board is also the licensing authority for physicians, dentists and other health service staff. In addition, the Board is the designated authority under European Community Directives for the mutual recognition of diplomas and certificates relating to the health professions.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

The licences are not given for a specific period of time, that is, health care personnel do not have to re-apply in order to keep their licence. However, in cases of malpractice the National Board of Health and Welfare can withdraw a licence after a decision by the HSAN (Medical Responsibility Board).

The National Board of Health and Welfare is the licensing authority for health care staff. After completing study and training programmes, physicians, nurses, dentists, pharmacists and other licensed health service staff can apply for a licence to practise their professions at the National Board of Health and Welfare. The licences are not granted for a specific period of time, that is, health care personnel do not have to re-apply in order to keep their licence.

4.26.6 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

Due to the well developed technology infrastructure in Sweden, program and course delivery strategies using online formats followed a different development path than that commonly found in the US The technical infrastructure in Sweden is so well developed that the Economist Intelligence Unit placed Sweden first among twenty nations as being the most ready to deliver online learning/teaching. Despite this, it was not until 2002 when Sweden committed SEK470 million (using today’s currency conversion rates: 79.5545 M USD) to create an institution called the Swedish Net University. The Swedish Net University (SNU) is a cooperative venture between 35 colleges and universities in Sweden that together can deliver more than 3,000 courses and 100 programs (Swedish Agency for Networks and Cooperation in Higher Education, 2008b) through a single portal. The mode of the courses offered through SNU includes both types W and M. For the M type courses (blended), the organization has a number of “Learning Centers” throughout the country of Sweden where students will congregate and meet with instructors for face-to- face instruction. Through these learning centers, students can also seek administrative, technical, and academic advice, as well as use the center’s computers. In addition to W (web only) type course, SNU offers some courses that are M, but there is no physical meeting. Instead, instructors and students use web cameras. According to SNU 2007 statistics, some Swedish universities are contributing the following number of courses (in parentheses): Dalarna University (435), Mid Sweden University, (282), University of Gävle (277), Umeå university (250) Karlstad University (248), and Uppsala University (220) (Swedish Agency for Networks and Cooperation in Higher

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Education, 2008a). One report states that 8% of university enrollment for 2007 in Sweden was students who registered to take courses through SNU, and two thirds of current SNU students study entirely online. Sweden is clearly targeting the development of online learning/teaching as a means to improve enrollment. The money and effort being spent, the development of a strong technical infrastructure, and the efforts to organize administrative departments and develop quality improvement policies indicate a sincere belief that this educational channel must and should be pursued.

4.26.7 Expenditure and Economics

In Sweden, medical education is entirely financed by the state.

The level of expenditure for core services, ancillary services is among the highest across OECD countries at USD 10 548 per student per year for primary, secondary and post- secondary non-tertiary education. Over the period 2008-11, combined public and private spending per student slightly increased at the primary, secondary and post-secondary non- tertiary levels of education, in line with the OECD average, as the result of a decrease in the number of students and stable expenditure levels. This increase is mainly supported by public spending which makes up the large majority of spending on educational institutions.

At tertiary level, including research and development, expenditure per student remained stable, as both enrolment rates and expenditure increased substantially. By comparison, 12 countries out of 31 decreased their expenditure per student at tertiary level. Public expenditure on educational institutions, slightly but steadily increased over both 2008-09 and 2009-11, while GDP fell over the period 2008-09. Still, the expenditure on education institutions as a share of GDP remained stable over the whole period, while the OECD average increased by 5 percentage points. It is also worth stressing that over the period 2008-11, Sweden prioritised education as a key public sector. As in about half of all OECD countries, public expenditure on education in Sweden grew faster than public expenditure on all services, while in the other half of countries the share decreased. In 2011, Sweden’s education budget amounted to 13.2% of total public expenditure, above the OECD average of 12.9%.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

4.27 United Kingdom

4.27.1 Educational System

Across the UK there are five stages of education: early years, primary, secondary, Further Education (FE) and Higher Education (HE). Education is compulsory for all children between the ages of 5 (4 in Northern Ireland) and 16. There are three main level of higher education course: Postgraduate courses leading to higher degrees, diplomas and certificates (including Doctorate, Masters, Postgraduate diplomas and certificates); undergraduate courses which include first degrees (honours and ordinary); and other undergraduate courses.

A higher education institution (HEI) is defined as i) a university, or ii) an institution conducted by a higher education corporation, or iii) a institution designated as eligible to receive support from public funds administered by the Higher Education Funding Council for England (HEFCE). At present, all English HEIs with the exception of the University of Buckingham and the University of Law receive support from funds administered by HEFCE and are listed here. HEFCE directly funds 128 HEIs. There are over 700 colleges and other institutions in the UK which do not have degree awarding powers, but which provide complete courses leading to recognised UK degrees. Courses at these institutions are validated by institutions which have degree awarding powers. These other providers of higher education programmes may use other institutional titles such as ‘college’. The use of such titles is not regulated by law. Public spending on education, total (% of GDP) in the United Kingdom was reported at 5.8 % in 2014.

4.27.2 Public Health Education and Educational Institutions

Several higher education institutions offer bachelor and master programmes in public health or related topics. For example, the University of Manchester offers a one-year intercalated Bachelor in Global Health, the Ulster University offers a four-year bachelor in Environmental Health, and the University of Sunderland offers a three-year bachelor in Public Health. Examples for Master programmes are the University of Liverpool that offers a 2,5-year Master in Public Health, the City University of London that offers a one-month Master in Public Health and the University of Roehampton that offers an online 2,5-year

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Master in Public Health. The University of West of Scotland offers a one-year Postgraduate Diploma in Specialist Community Public Health Nursing.

4.27.3 Expenditure and Economics in Public Health

Public health expenditure, total (% of GDP) in the United Kingdom was reported at 7.6 % in 2014.

4.27.4 Challenges and Future Perspectives

The UK Public Health Educators in Medical Schools (PHEMS) is a voluntary network of UK- based public health educators involved in undergraduate medical teaching that offers peer support network and forum for sharing good practice in public health education. In 2016, with the support of the Faculty of Public Health, PHEMS have produced a consensus statement on ‘core’ content of learning in public health that a graduate should achieve in any UK medical school, irrespective of curriculum design. The document updates previous statements on public health education in medical schools. It compares key learning outcomes/curricular content in different medical schools (the ‘what’); considers the processes and resources required for effective delivery of teaching programmes (the ‘how’); and considers examples of ‘best practice’. It provides a basis for the furtherance of educational development in medical schools.The consensus statement suggests ways in which public health teaching can form an underpinning theme across all clinical training to address these issues. The General Medical Council (GMC) recently announced the likely development of a national licensing examination for UK medical graduates in line with current practice in other countries like USA and Canada. This heightens the need for an agreed syllabus for undergraduate medical education.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

5. Public Health Education Best Practices in other Countries 5.1 Australia

5.1.1 Description of Educational System, Structure and Management, Students Demographics, Legislation

Education in Australia generally comprises primary education (primary schools), followed by secondary education (high schools), and tertiary education (universities, TAFE colleges, and vocational education and training providers). For a country of just over 20 million it is remarkable to an outsider, and somewhat less so to the average Australian, that each State and Territory in Australia maintains its own education system - eight systems in total. Each of the state and territory curriculums does however share a great deal in common although the exams, assessment processes and the name of the ultimate school leaving certificate may vary. There is also some variation in their approaches to pre-school education and when the transition is made from primary to secondary school. Primary schooling in most states and territories begins with a preparatory or kindergarten year, followed by six or seven primary grades, then a further five or six years to complete a full secondary course of study. In total, states and territories offer 13 years of schooling. Australian universities are autonomous self-accredited institutions established by Federal, State or Territory legislation. Post-compulsory education is regulated within the Australian Qualifications Framework, a unified system of national qualifications in schools, vocational education and training, and the tertiary education sector. Australia recognizes the following School leaving and higher education credentials:

 Junior Secondary Certificate of Education (First Cycle)

 Senior Secondary Certificate of Education (Second Cycle)

 Certificate I, II, III and IV

 Diploma

 Advanced Diploma

 Bachelor Degree

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Bachelor Honours Degree

 Graduate Certificate

 Graduate Diploma

 Master Degree

 Master Honours Degree

 Doctorate

 Higher Doctorate The academic year in Australia varies between States and institutions, but generally runs from late January/early February until early/mid-December for primary and secondary schools, with slight variations in the inter-term holidays and TAFE colleges, and from late February until mid-November for universities with seasonal holidays and breaks for each educational institute.

The regulation, operation, and funding of education is primarily the responsibility of the States and territories, partly because the Federal Government does not have a specific constitutional power to pass laws with respect to education. However, the Federal government helps fund independent or private schools, helps fund public universities and subsidises tertiary education through a national student loan scheme, and regulates vocational education providers. The Federal Government's involvement in education has been the responsibility of a number of departments over the years, the present version of which is the Department of Education and Training.

5.1.2 Public Health Educational Institutions

CAPHIA is the peak organisation that represents public health in universities that offer undergraduate and postgraduate programs and research and community service activity in public health throughout Australia. Its purpose is to maintain high quality academic standards in the education and development of public health practitioners and researchers, to lead and represent public health education in the tertiary sector and to be a respected voice and advocate for the development of public health professionals and researchers within Australia.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Full Membership is open to schools and disciplines of public health in tertiary academic institutions that offer programs, research and community service activity in public health throughout Australia. The list of CAPHIA Institutions with Full Membership counts 26 Universities.

1. AUSTRALIAN NATIONAL UNIVERSITY - the Research School of Population Health, formed on July 1 2012, strives to improve the population's mental and physical health through discovery, education and the translation of research into effective health policy and practice, working on problems in Australia, and internationally. 2. CHARLES DARWIN UNIVERSITY -Menzies School of Health Research delivers postgraduate public health and health research courses and administratively supports higher degree research (HDR) students. 3. CURTIN UNIVERSITY - School of Public Health offers undergraduate and postgraduate studies in a few public health programmes. 4. DEAKIN UNIVERSITY - The School of Health and Social Development run a number of programs that aim to educate and inform communities of significant public health issues. 5. EDITH COWAN UNIVERSITY - School of Exercise and Health Sciences has the largest Nursing program and the only dual Nursing/Midwifery degree in Western Australia, as well as postgraduate nursing studies. 6. FLINDERS UNIVERSITY -Public Health offers postgraduate studies and it is committed to local and global action to address social factors leading to illness and health inequities. 7. GRIFFITH UNIVERSITY - Public Health and Health Promotion offers bachelor, graduate and master studies.

8. JAMES COOK UNIVERSITY - College of Public Health, Medical and Veterinary Sciences offers different under and post graduate programmes. 9. LA TROBE UNIVERSITY - School of Psychology & Public Health provides several bachelor programmes.

10. MACQUARIE UNIVERSITY - Department of Health Systems and Populations provides master studies.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

11. MENZIES SCHOOL OF HEALTH RESEARCH - Menzies School of Health Research organise graduate and master courses in public health.

12. MONASH UNIVERSITY - School of Public Health and Preventive Medicine provides undergraduate and postgraduate courses.

13. QUEENSLAND UNIVERSITY OF TECHNOLOGY - School of Public Health and Social Work provides bachelor diplomas. 14. TORRENS UNIVERSITY AUSTRALIA – Public Health Department, in addition to undergraduate and postgraduate courses organise short courses for professional development. 15. UNIVERSITY OF ADELAIDE - School of Population Health provides undergraduate and postgraduate coursework. 16. UNIVERSITY OF MELBOURNE - Melbourne School of Population and Global Health provides studies at all levels (BSc, MSc and PHD) and short courses.

17. UNIVERSITY OF NEWCASTLE - School of Medicine and Public Healthstrengths are the Joint Medical Program and postgraduate programs in population health.

18. UNIVERSITY OF NEW SOUTH WALES - School of Public Health and Community Medicine has several master programmes in public health. 19. UNIVERSITY OF QUEENSLAND - School of Public Health organise bachelor and postgraduate studies. 20. UNIVERSITY OF SOUTH AUSTRALIA - School of Population Health provides under and post graduate courses. 21. UNIVERSITY OF THE SUNSHINE COAST - School of Health and Sport Sciences offers several bachelor programmes. 22. UNIVERSITY OF SYDNEY - Sydney School of Public Health provides postgraduate studies and professional development short cources.

23. UNIVERSITY OF TASMANIA - Medicine and Paramedicine, Faculty of Health orginize short trainings, in addition to undergraduate and postgraduate studies.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

24. UNIVERSITY OF WESTERN AUSTRALIA - School of Population and Global Health has bachelor and master studies.

25. UNIVERSITY OF WOLLONGONG - School of Health and Society organise bachelor and postgraduate studies.

26. WESTERN SYDNEY UNIVERSITY -School of Science and Health has undergraduate and postgraduate studies. Affiliated CAPHIA membership has the AUSTRALASIAN FACULTY OF PUBLIC HEALTH MEDICINE,AUSTRALIAN CATHOLIC UNIVERSITY, UNIVERSITY OF CANBERRA and UNIVERSITY OF NOTRE DAME.

5.1.3 University Program in Public Health – both Undergraduate and Postgraduate

In Australia exists 93 Public Health Bachelor's degrees programmes and 147 Public Health Master's degrees programmes. Compared to the large number of graduate and postgraduate programmes, the curious is the information that there are only 3 universities that offer PHD programmes in public health.

5.1.4 Continuing Education, Lifelong Learning

In Australia 4 public health educational institutions organise short courses to give access to raise awareness, improve knowledge and have up-dated professionals in healthcare systems. The health courses offered by Torrens University Australia are available online, with a few courses delivered on our Adelaide, Sydney and Melbourne campuses. University of Melbourne has three departments that organise different types of courses – Centre for Health Equity, Centre for Health Policy and Nossal Institute. The University of Sydney provides professional development trough courses that are offered as two-day or four-day workshops. Others are available one night a week for several weeks (usually seven). University of Tasmania has Continuing Professional Development Unit for the purpose of lifelong education.

5.1.5 Public Health Professionals’ Certification (Legislation)

A National Registration and Accreditation Scheme (NRAS) for health practitioners started on 1 July 2010. The NRAS has been established by state and territory governments to:

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

protect the public by ensuring that only suitably trained and qualified practitioners are registered; facilitate workforce mobility across Australia; enable the continuous development of a flexible, responsive and sustainable Australian health workforce.

5.1.6 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

The large number of Health Care Educational Institution do not provide online courses, but all universities that organise short trainings for professionals use for that purpose e- learning platforms. There are only two Master programmes that are completely remote, both at Australian Catholic University:

 Australian Catholic University - Clinical Education, Master

 Australian Catholic University - Public Health, Master

5.1.7 Expenditure and Economics

Operating expenditure on education by all levels of general government increased by 3,286m $ (3.9%), from 84,571m $ in 2014-15 to 87,857m $ in 2015-16. Total expenditure on education by the Commonwealth Government was 32,312m $, with expenditure by the state and local governments totalling $58,352m. Intra-sector transfers were 29,485m $. Of the total operating expenditure on education in 2015-16, $51.5% was spent on primary and secondary education and 36.0% on tertiary education (universities and TAFEs). 5,3% of GDP is spent on education, in Australia.

5.1.8 Challenges and Future Perspectives

The challenges in educational area in Australia are to raise the status of teaching as a career choice, to attract more able people into teaching and to develop teaching as a knowledge- based profession and to reduce the disparity between the schooling experiences of students in Australia’s most and least advantaged schools.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

5.2 Canada

5.2.1 Description of the Educational System, Structure and Management

Education in Canada is funded and overseen by federal, provincial and local governments. Education is within provincial jurisdiction and the curriculum is overseen by the province. Education across Canada is generally divided into four stages: pre-school or early childhood education; primary or elementary education; secondary education and post- secondary or tertiary education, which includes college and university programs and vocational/technical schooling37. The education system in Canada encompasses both publicly-funded and private schools, including: community colleges/ technical institutes, career colleges, language schools, secondary schools, summer camps, universities and university colleges38. There are many variations between the provinces responsible for elementary, secondary and post-secondary education. For example, education is compulsory up to age of 16 everywhere but in Ontario and New Brunswick where the compulsory age is 18. In addition to public schools, there are also thousands of private schools in Canada, both secular and religious-based institutions. All publicly funded schools are under authority of their local district school boards. There are some exceptions, such as Alberta, which allows public charter schools, which are independent of any district board (they have their own board, which reports to the province).

Related to post-secondary education, the following facts are characteristic for Canada39:

 Term college usually refers to a community college or a technical, applied arts, or applied science school. These schools are post-secondary institutions that grant vocational certificates, diplomas, and associate degrees.

 A university in Canada is an institution of higher education and research, which grants academic degrees in a variety of subjects. It provides both undergraduate education (typically takes 3-5 years to complete (depending on the province and

37http://www.studycountry.com/guide/CA-education.htm 38http://www.studycanada.ca/english/education_system_canada.htm 39http://www.studycountry.com/guide/CA-education.htm | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

class availability)) and postgraduate education (A Master of Arts or Master of Science is known as a graduate degree, one that typically takes two years to complete; The Doctorate or PhD degree is a specialized post-graduate degree that can take anywhere from 3-6 years to complete).

 Vocational Schools and Apprenticeships.In addition to community colleges, which offer some vocational training, students can also learn a vocation or trade at one of the many private vocational and technical schools scattered throughout the country, or via an apprenticeship program (which allows students to learn the skills they need for a given trade by working hands-on in that environment under a qualified supervisor). Canada has 163 recognized public and private universities (including theological schools) and 183 recognized public colleges and institutes, including those granting applied and bachelor's degrees. In addition to the recognized institutions, there are 68 university-level institutions and 51 college-level ones operating as authorized institutions.

5.2.2 Students Demographics, Legislation

 On December 31st 2015, 356,574 international students were present in Canada –an increase of 191% compared with December 31st 2000.

 In 2015, international students came from more than 185 countries.

 The top three source countries were China (120,339 or 33.7%), India (48,914 or 13.7%) and France (20,218 or 5.7%) and together accounted for 53.1% of the total of the international students.

 The following countries were source of more than or equal to one percent of international students to Canada: South Korea (5.6%), the United States of America (3.4%), Saudi Arabia (3.3%), Nigeria (2.8%), Brazil (2.1%), Japan (2.0%), Mexico (1.4%), Vietnam (1.4%), Iran (1.3%), Pakistan (1.1%) and Hong Kong (1.0%).40

 Canada Student Loans are offered by the Government of Canada to help students pay for post-secondary education at a designated college, university, or other post- secondary institution.

40 The Canadian Magazine of Immigration, http://canadaimmigrants.com/canada-international-students-by- country-2015/ | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 This matter is precisely regulated by Canada Student Loans Regulations41 .

5.2.3 Public Health Educational Institutions

Different institutions in Canada are focused on education and training in the filed of public health, and more details about their programs will be provided below. In this section, few associations and organisations relevant to public health education in Canada are listed, as follows:

 CIPHI (http://www.ciphi.ca/) represents and unites Environmental Public Health professionals across Canada. We advance the profession and field of Environmental Public Health through certification, advocacy, education and professional competencies. Through this we protect the health of all Canadians.

 CASN/ACESI (Canadian Association of Schools of Nursing/Association canadienne des écoles de sciences infirmières) (http://www.casn.ca/)is the national voice for nursing education, research, and scholarship and represents baccalaureate and graduate nursing programs in Canada. The key objective of CASN/ACESI is defined as: To lead nursing education and nursing scholarship in the interest of healthier Canadians.

 ALPHA (Association of Local public health Agencies) (http://www.alphaweb.org/) is a not-for-profit organization that provides leadership to the boards of health and public health units in Ontario. One of their activiteis is focused on helath promotion and organisation of different in-formal educational prorgams, summer and winter schools in public health, etc.

5.2.4 University Programs in Public Health both, Undergraduate and Postgraduate

Many universities in Canada provide Baccalaureate, Graduate and Postgraduate degree in health promotion and public health sciences. The following Table 5.2.4.1 summarizes few programs available at recognized universities, exemplifing a whole umbrella of progarams and specialisations in the fields of public

41Justice Laws Website, http://laws-lois.justice.gc.ca/eng/regulations/SOR-93-392/page-1.html#docCont | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

health. Comprehensive list of available programs in Ontario can be found at the following web-site: http://www.ohpe.ca/node/8891

There are 17 medical programs offering a medical doctorate (MD) in Canadian universities. The programs vary in length from three years (McMaster University and University of Calgary) to the more typical four-year program including the clinical practicum (CIHI, 2011a). After graduating, medical students enter a residency program in family practice or some specialization and complete their training – a minimum two-year residency program in the case of family practice and four or more years in other specialties in medical, surgical and laboratory medicine.

Table 5.2.4.1. Level School Description Undergraduate Laurentian University Bachelor of Physical Health and Programs Education University of Waterloo Bachelor of Health Science Degree

University of Western Bachelor of Health Sciences Ontario

Brock University Workplace Health, BA Honours (co-op) Centennial College Workplace Wellness and Health Promotion Graduate/ Queen's University Community Health and Master Programs Epidemiology Universite Laval Faculty of Medicine Epidemiology University of Alberta Public Health Sciences

University of Manitoba Faculty of Medicine Community Health Sciences University of Northern Community Health British Columbia University of Saskatchewan Community Health and Epidemiology

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

University of Toronto Department of Public Health Sciences Memorial University of Graduate Diploma in Community Newfoundland Health

Dalhousie University MSc in Community Health and Epidemiology Athabasca University (distance education) Master of Health Studies Memorial University of MSc in Community Health Newfoundland UBC School of Population Master of Health Administration and Public Health Master of Health Science Master of Public Health Master of Science in Occupational and Environmental Hygiene Master of Science in Population and Public Health Residency Public Health & Preventive Medicine Simon Fraser University Master of Public Health (MPH) Master of Health Science (MSc)

Laurentian University Interdisciplinary Health (MA or M.Sc.) University of Waterloo Master of Public health (School of Public Health Master of Health Informatics and Health Systems) Master of Health Evaluation MSc in Public Health and Health Systems (research degree) PhD programs UBC School of Population PhD in public health and Public Health Simon Fraser University PhD in Health Science University of Waterloo PhD in Public Health and Health (School of Public Health Systems and Health Systems) Collaborative PhD Aging, Health

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

and Well-being Collaborative PhD Work and Health

It is important to highlight that UBC School of Population and Public Health Vancouver Canada is accredites under APHEA (Agency for Public Health Education Accreditation). APHEA (http://aphea.net/) represents the five leading associations of public health in the European Region and is committed to assuring and improving the quality of educational activities throughout the European Region and the globe.

5.2.5 Continuing Education, Life Long Learning

Similarly to different study programs available at Canadian universities, professional specialization certificate programs are also available moslty (co-)organised by universities, as follows.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Table 5.2.5.1. Institution Certificate program Description

University of Victoria: Professional Specialization Designed to meet the needs Continuing studies Certificate in Population of professionals in Health Data Analysis population and public health (and related social science disciplines) including analysts, policy makers and researchers who are seeking education and professional development in advanced population health analysis

Population Data BC in Online Certificate Program Program covers broad array partnership with the in Population Health Data of techniques applicable to Division of Continuing Analysis the analysis and Studies at the University of interpretation of health data, Victoria including data requirements, data formats and the appropriate choice of analytic methodology.

University of Alberta Professional Certificate in This program is designed for Public Health practitioners and clinicians working in health services, health systems, government and non-governmental organizations.

5.2.6 Public Health Professionals Certification (Legislation)

In 1935 the Canadian Public Health Association established qualifications for inspectors relating to post secondary school education and technical training, and conducted examinations for Certification, awarding a Certificate in Sanitary Inspection. In 1963 there was a change in designation from Sanitary Inspector to Public Health Inspector. The

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Certificate in Public Health Inspection (Canada) is recognized by the departments of health and other agencies in Canada as evidence of satisfactory training. In the establishment and conduct of certification, the Association had the co-operation and assistance of Federal, Provincial and local Health Authorities and the Canadian Institute of Public Health Inspectors.42

The National Board of Public Health Examiners (NBPHE) board of directors determinate criteria for the Certified in Public Health (CPH) exam. Individuals who have a bachelor’s degree and at least five subsequent years’ public health work experience will be eligible to take the CPH exam.

5.2.7 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

Distance learning approach is widely used across Canada, and several universities are very well known worldwide in providin distance laerining prorgams and courses, naming just a few:

 Athabasca University:Athabasca University was the first university in Canada to focus on distance education. It’s been their specialty since 1972: http://www.athabascau.ca/

 Canadian Virtual University(CVU) is a partnership of 12 universities across Canada that offer complete degrees, diplomas, and certificates online and through distance education. Students can enrol in over 2300 courses and 300 complete programs from one web site: http://www.cvu-uvc.ca. Furthermore, other relevant associations and organisations in public health also provide ICT support to education and learning, such as:

 Public Health Agency of Canada: they have recently developed new e-learning portal (https://training-formation.phac-aspc.gc.ca/) which replaces the Biosafety e-Learning and Training Resources and the Emergency Preparedness and Response portals.

42http://www.ciphi.ca/careers/board-of-certification/ | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 Ontario Public Health Association (http://opha.on.ca/What-We- Do/Projects/Built-Environment.aspx): Online Course for Public Health and Planning Professionals to Create Healthier Built Environments. The online course format consists of short videos, exercises, interactive activities and supporting resources, self-examinations (multiple choice quizzes), and reading, all developed and distributed via learning platform, ACTO.

5.2.8 Expenditure and Economics43

Table 5.2.8.1. 2009 2010 2011 2012 2013 2014 Government expenditure on 4.87% 5.37% 5.27% n/a n/a n/a education as % of GDP (%) Government expenditure on tertiary education as % of 1.76% 1.90% 1.88% 1.73% n/a n/a GDP (%) Government expenditure per tertiary student as % of GDP n/a n/a n/a n/a n/a n/a per capita (%)

In terms of educating and training health providers, provincial ministries of health work in tandem with provider organizations to set or alter the number of “seats” or entry positions in professional programs in postsecondary institutions. Since education is exclusively within the jurisdiction of the provinces and almost all education in Canada is financed publicly, provincial governments determine the funding for the postsecondary education of the health professions that is delivered by universities, colleges and technical institutions.44

43 Source for data in tables: UNESCO Institute for Statistics available at: http://databank.worldbank.org/data 44Gregory P. Marchildon. Canada: Health system review. Health Systems in Transition, 2013; 15(1): 1 – 179, pp. 95 | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

5.3 Japan

5.3.1 Description of the Educational System, Structure and Management

Japan education system has more or less remained the same ever since it’s setting up after World War II. It was influenced by the German and US education system. The Ministry of Education, Culture, Sports, Science and Technology (MEXT) is responsible for all education in Japan. The Japanese education system has a centralized structure. MEXT publishes guidelines for the national curriculum of primary, lower and upper secondary school education. The Japanese school system is often described as a 6-3-3-4 system, based on the number of years spent in each of the respective schools. The education system is sub-divided into pre- school, elementary school, junior-high school, high school and university.45 Most pupils opt to take high school entrance exams after 9 year compulsory period (primary education (6 year period) and lower secondary education (3 year period)). The contents of this exam are carried out by the municipal Board of Education where secondary school is located. In terms of private school examinations, each school decides its own methods of examination.

The upper 3 grades of secondary education are regarded as the most strenuous school period (ages 15-18) and are provided by high schools. Students must also go through examination before entering higher education institutions.

Higher education is provided at:

 universities (offering Bachelor’s, Master’s and doctoral programs),

 junior colleges (providing programs with a professional focus to lead to an associate degree- mainly focused on the following departments- home economics, education, nursing, humanities and sociology),

45http://japan.ahk.de/en/japan-info/customs-culture/education-system/ | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

 colleges of technology (provide courses in engineering field, merchant shipping and other related areas of study, which lasts for 5 years (five and half for the mercantile marine course)

 professional training colleges (vocational and technology-related education as well as education in the enhancement of skills and knowledge required in life; specialized training in a particular industry or career.). These can be National, public and private, where national universities holds the highest regard. Public universities are local institutions managed at municipal level.

Total Number of Higher Education Institutions46:

 Universities-783 (Out of which 86 are National, 92 are Local, and 605 are Private Universities)

 Junior Colleges-372 (Out of which 22- are Local and 350 are Private Junior Colleges)

 Colleges of Technology- 57 (Out of which 51- are National, 3 are Local, and 3 are Private Colleges of Technology) Source: MEXT, School Basic Survey (2012)

5.3.2 Students Demographics, Legislation

Number of international students in Japan by country of origin (Gatway to stady in Japan)

Table 5.3.2.1. Number of Percentage Country/region of origin international students (%) (persons)

1 China 81,884 60.4%

2 Republic of Korea 15,304 11.3%

46http://www.japaneducation.info/Higher-Education/index.html | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

3 Vietnam 6,290 4.6%

4 Taiwan 4,719 3.5%

5 Nepal 3,188 2.4%

6 Indonesia 2,410 1.8%

7 Thailand 2,383 1.8%

8 Malaysia 2,293 1.7%

9 United States of America 2,083 1.5%

10 Myanmar 1,193 0.9%

11 Others 13,772 10.2%

Total 135,519 100.0%

EJU is an exam to test international students planning to study in Japan on their Japanese proficiency and basic academic abilities (Japanese as a Foreign Language, Science, Japan and the World and Mathematics). It is used by more than 600 universities (undergraduate program) and other higher educational institutions as an entrance exam. EJU can be taken without having to come to Japan as it is conducted at 17 cities spanning over 14 foreign countries.

5.3.3 Public Health Educational Institutions

The foremost institute for education, medical and biosience research in Japan is established in 1892 and named Empire of Japan Private Sanitation Meeting Attachment Institute of Infectious Diseases. In 1967, it was reorginized and Institute of Medical Sciencewas established by Tokio University. A research hospital is attached to the institute.

As part of Teikyo University, there is the Graduate School of Public Health, the first graduate school in Japan to offer courses in public health. The School offers a range of vocational courses geared towards practical professional skills (as opposed to research) and doctoral courses that address the challenges of reform and innovation in the rapidly- changing health care sector.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

The Kyoto University School of Public Health was established in 2000, and was the first institution of its kind in Japan, offering the degrees of Master of Public Health and Doctor of Public Health. The school explores the integrated socio-ecological approach for health, referred to as the “New Public Health.” This School combines classic public health fields such as communicable and chronic disease control, family health, nutrition and environmental health with new fields such as clinical epidemiology, pharmacoepidemiology, socioepidemiology, behavial science, health promotion, informatics, economics, and ethics.

5.3.4 University Programs in Public Health both, Undergraduate and Postgraduate

Medical education in Japan is a six-year course enrolling high school graduates. New technologies have been rapidly developed, particularly in recent years, and new specialized departments have been established in many medical schools so that the curriculum is now shared among these various departments. As a result, it has become difficult for medical schools to maintain a curriculum that familiarizes students with the general principles needed for future primary health care practice. The Ministry of Education and Science published a core curriculum model in 2001 to encourage medical schools to promote standardized education in order to graduate students with general common knowledge focused on primary health care47. Nursing professionals, including public health nurses and midwives, are usually graduates of specified professional schools rather than universities. This was not considered to be a satisfactory education system for health professionals because of which nursing departments started to establish in national universities, in 1975, which was considered as a pioneer at that time. Many prefectures started to build new university-level schools for health professionals from around the 1990s. The number of nursing universities has increased rapidly recently from 76 in 1999 to 146 in 2006.48

47Source: Tatara K, Okamoto E. Japan: Health system review. Health Systems in Transition, 2009; 11(5): 1–164. pp.93 48IBID. pp.92. | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Table 5.3.4.1. Level School Description Undergraduate Teikyo University, Faculty Orthoptics Programs of Medical Technology Radiological Technology Clinical Laboratory Science The University of Tokyo School of Medicine Department of Department of Molecular Public Health / Health Preventive Medicine Policy School of Health Sciences and Nursing Graduate/ University of Tsukuba Master in Public Health Master Programs The University of Tokyo Global Health Sciences: Master Program in International Health Nagoya University Young Leaders - Master in Healthcare Administration Teikyo University, Graduate Master's Degree in Public Health School of Public Health The Kyoto University Master of Public Health School of Public Health The University of Tokyo Health Policy (MSc) Department of Public Health Crisis Management Public Health / Health (MSc) Policy Public Health Practice (MSc)

PhD programs Teikyo University, Graduate Doctorate in Public Health School of Public Health The University of Tokyo Doctor of Public Health Department of Public Health / Health Policy The Kyoto University Doctor of Public Health School of Public Health

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

5.3.5 Continuing Education, Life Long Learning

National Institute of Public Health was established on 1st April 2002, integrating The Institute of Public Health, National Institute of Health Services Management and a part of the Department of Oral Science in National Institute of Infectious Disease. The mission of the new organization is to carry out education and training of the personnel engaging in the works of public health, environmental hygiene and social welfare, and to conduct research in these areas.

5.3.6 Public Health Professionals Certification (Legislation)

Act on Public Health Nurses, Midwives, and Nurses (Act No. 203 of 1948)49

The purpose of this Act is to improve the quality of Public Health Nurses, Midwives, and Nurses, and to thereby expand and improve medical care and public health. Article 7 defines that:

(1) A person seeking to become a Public Health Nurse must pass the National Public Health Nursing Examination and the National Nursing Examination and receive licensure from the Minister of Health, Labour and Welfare. (2) A person seeking to become a Midwife must pass the National Midwifery Examination and National Nursing Examination and receive licensure from the Minister of Health, Labour and Welfare. (3) 3) A person seeking to become a Nurse must pass the National Nursing Examination and receive licensure from the Minister of Health, Labour and Welfare.

49http://www.japaneselawtranslation.go.jp/

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

5.3.7 ICT Applications in Learning, E-Learning, Telemedicine Networks for Education

E-Learning in Japan has a strong political connotation as the Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) has been promoting the development of e-learning in higher education institutions in Japan as part of the e-Japan Initiative since 2001. In January 2006, “IT New Reform Strategy” was put forth by the Japanese government, succeeding the “e-Japan Strategy.” In the field of education, the strategy aimed to double the number of departments and programs who conduct e- learning and also to double the number of life-long learners who take e-learning courses.

Japan is in an ideal position to use telemedicine and remote monitoring for two reasons: 1) it has the technological infrastructure and sophistication to support and rapidly implement it, and 2) more than 20% of Japan’s population is over the age of 65, and this percentage is expected to rapidly increase. In providing home care for this population, telemedicine and remote monitoring capabilities will be increasingly important.

KOHOEN is a social welfare organization in Japan. One of its primary missions is to improve and provide community-level care, and to promote team-based care among doctors, nurses, pharmacists, and care managers. It equips care teams and patients with remote care tools, which in turn help older individuals live at home and maintain independence.

5.3.8 Expenditure and Economics50

Table 5.3.8.1. 2009 2010 2011 2012 2013 2014 Government expenditure on n/a 3.78% 3.78% 3.85% 3.82% 3.76% education as % of GDP (%) Government expenditure on tertiary education as % of n/a 0.76% 0.74% 0.78% 0.76% 0.78% GDP (%) Government expenditure per tertiary student as % of GDP n/a 25.35% 24.28% 25.50% 25.22% n/a per capita (%)

50 Source for data in tables: UNESCO Institute for Statistics available at: http://databank.worldbank.org/data | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Changes in education system aimed to cut public spending introduced change of organizational structure of higher education institutions, and after National University Corporation Law was legislated on April 1, 2004, all of the national universities, including 42 national medical schools, became “national university corporations.” This change required the universities to take responsibility for their own finances and financial management. 51 5.4 USA

5.4.1 History

Harvard T.H. Chan School of Public Health traces its roots to public health activism at the beginning of the last century, a time of energetic social reform. The School began as the Harvard-MIT School of Health Officers, founded in 1913 as the first professional public health training program in America. The School of Hygiene and Public Health at Johns Hopkins was founded in 1916 with funding from the Rockefeller Foundation. The school was the first of its kind in the United States and became enormously influential in the field.

5.4.2 Educational Spectrum

Graduate programs in public health lead to degrees such as Master of Public Health (MPH), Master of Science in Public Health (MSPH), Doctor of Philosophy (PhD), or Doctor of Public Health (DrPH). Coursework focuses on disciplines such as administration, epidemiology, environmental health, biostatistics, health policy, and behavioral health. Some public health programs of study lead to an academic degree for research and teaching careers and others lead to a professional degree for work in the private, public and non-profit heath sectors. Public health master's degree programs specialize in areas like biostatistics, environmental health, community health education, global health, epidemiology, and public health administration.

5.4.3 Accreditation

The Council on Education for Public Health (CEPH) is the nationally recognized accrediting body for both schools of public health and public health programs. The Council on Education for Public Health has registered 2540 public health degree programs. Out of

51 Source: Kozu, T. “Medical Education in Japan”, Acad Med. 2006 Dec;81(12):1069-75. pp.1069. | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

these 1447 are master public health programs, and 143 programs are available online. Public health master's degree programs specialize in areas like biostatistics, environmental health, community health education, global health, epidemiology, and public health administration. 318 programs are accredited by CEPH. The Association of Schools and Programs of Public Health (ASPPH) is a membership organization of accredited academic public health, representing schools and programs accredited by the CEPH consisting of 50 organizations.

5.4.4 Ranking of Public Health Education – Top 10 by US News and World Report Ranking

Universities rankings use calibrated performance indicators to provide comprehensive and balanced comparisons available, which are trusted by students, academics, university leaders, industry and governments. According to US News and World Report Ranking of Top Graduate Public Health Programs, rankings for medicine and health related subjects are based solely on the results of peer assessment surveys sent to deans, other administrators and/or faculty at accredited degree programs or schools in each discipline. All schools surveyed in a discipline are sent the same number of surveys. Respondents rated the academic quality of programs on a scale of 1 (marginal) to 5 (outstanding). They were instructed to select "don't know" if they did not have enough knowledge to rate a program. Only fully accredited programs in good standing during the survey period are ranked. According to US News and World Report Ranking of Top Graduate Public Health Programs, the best graduate degrees in public health are provided by the following schools:

1, Johns Hopkins University The Johns Hopkins Bloomberg School of Public Health is dedicated to “the education of a diverse group of research scientists and public health professionals, a process inseparably linked to the discovery and application of new knowledge, and through these activities, to the improvement of health and prevention of disease and disability around the world.” The Bloomberg School offers students nine different graduate Public Health degree programs to choose from. Each student can choose a plan that works with his or her goals, lifestyle and interests. In addition to these nine degree programs, there are an additional nine concurrent degree programs to allow students the opportunity to either further specialize their education.

2/3, Harvard University

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

The Harvard School of Public Health is among the most respected in the worldwide. Graduate students can choose to study in one of the following programs: Biostatistics, Environmental Health, Epidemiology, Genetics and Complex Diseases, Global Health and Population, Health Policy and Management, Immunology and Infectious Diseases, Nutrition and Social and Behavioral Sciences. Each one of these areas has its own dedicated department and faculty.

2/3, University of North Carolina – Chapel Hill, North Carolina Consistently recognized as one of the top public health schools in the nation, the Gillings School of Global Public Health has been home to the top public health leaders and students for over 75 years. The mission is to improve public health, promote individual well-being and eliminate health inequities across North Carolina and around the world. The school offers both master’s and doctoral degrees in a range of specialty areas including: Biostatistics, Environmental Sciences and Engineering, Epidemiology, Global Health, Health Behavior, Health Policy and Management, Maternal and Child Health, Nutrition and Public Health Leadership.

4, University of Michigan—Ann Arbor

The University of Michigan School of Public Health continuously works to create and disperse knowledge and information with the goal of preventing disease and promoting the overall health of populations throughout the world. There is a specific focus on health equity and the curriculum has been created with a focus on disadvantaged populations who suffer disproportionately from illness and disability. The School of Public Health is committed to the following core values:

Improved health for populations and individual’s worldwide, Health equity for all people, Diversity and inclusion in education, research and service, Ethical principles of teaching, learning, research and practice, Excellence and innovation, Equitable partnerships with individuals, communities, and practitioners. 5, Columbia University – New York, New York

The Mailman School of Public Health is one of the most widely respected Public Health graduate programs in the United States. The school offers study in six individual specialty areas of Public Health, including: Biostatistics, Environmental Health Sciences, Epidemiology, Health Policy & Management, Population & Family Health and Sociomedical Sciences. Each one of these unique departments offers students master’s and doctoral level

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

degree programs. Students can choose from the many interdisciplinary degree programs to either enhance their existing career or create a new path.

6, University of Washington The UW School of Public Health is dedicated to three core values. They include: Education to prepare outstanding, innovative, and diverse public health leaders and scientists; Research to advance public health science and policies; Service to promote the health and well-being of communities locally, nationally, and globally. Public health is viewed as being of both local and global importance. The School of Public Health has individual departments in Biostatistics, Environmental & Occupational Health Sciences, Epidemiology, Global Health, and Health Services. 7, Emory University

Master’s in Public Health students enrolled in the Rollins School of Public Health (RSPH) learn to identify, analyze, and mediate in some of the most pertinent public health issues throughout the community and the country. Master of Public Health with Optional Specialization in Behavioral Sciences and Health Education, Biostatistics, Environmental Health, Epidemiology, Health Policy and Management, Global Health are available. 8, University of Minnesota The mission of the School of Public Health at the University of Minnesota is “Through excellence in education, research and community engagement, the University of Minnesota School of Public Health advances health – from scientific discovery to public impact – by enhancing population health and preventing disease in the U.S. and globally.” The school offers extensive training in a number of areas of public health to serve the community, the country and the world.

9, University of California—Berkeley

The School of Public Health at UC Berkley supports both master’s and doctoral degree programs in an extensive range of public health disciplines. The fully accredited graduate Public Health degree program vision statement is “Building on a campus tradition of pre- eminent interdisciplinary and transdisciplinary scholarship, education and public engagement that challenges conventional thinking, the University of California, Berkeley,

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

School of Public Health develops diverse leaders equipped to help solve the health challenges of the 21st century and beyond.”

10/11, Boston University The Boston University School of Public Health features nineteen Public Health Graduate degree programs and eight dual-degree programs. Each of these programs offers students the integration of classroom education, research, and hands-on experience. Graduate students have the opportunity to assist faculty members in a range of public health research projects. The skills-based curriculum, practicum program, and extensive community-based service programs prepare graduates for careers in research, industry, government, and academia. 10/11, University of California—Los Angeles

The Mission of the UCLA Fielding School of Public Health is “to enhance the public’s health by conducting innovative research, training future leaders and health professionals from diverse backgrounds, translating research into policy and practice, and serving our local communities and the communities of the nation and the world.” 6. Conclusions

This report provided an overview of public health educational practices in EU and other countries. The report started with definitions of the public health domain and proceeded with brief historical aspects of public health education. Furthermore, it collected country descriptions on the basis of educational system organisation and existing programmes in public health. These country descriptions provided the way to compare and collect best practices in assisting the authorities of Montenegro to select and compare practices in EU and elsewhere with their own practices in Public Health Education.

Health education forms an important part of the health promotion activities currently occurring in different countries, and that is a reason why several organizations highlights objectives related to educational approaches within their strategies. In many cases, listed strategies are regarding health education in general but directly applicable to public health education.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Strategic objectives related to public helath education are the following: (a) Improving quality of academic programmes and continuing professional development (CPD) for public health; (b) Setting up a public health profession for public health services in Europe; (c) Developing the global dimension of education and training for public health. (d) Develop tools for individual career and systems human capacity planning based on the relationship between population health challenges, essential public health operations (EPHOs), and competences. Develop European lists of public health core competences for all categories of public health workforce and for all educational and training levels.

Support the shaping of a professional identity and culture in schools of public health and national associations of public health. From the overview of the countries description on education in Public Health we have seen that the Schools of public health offer a variety of degrees which generally fall into two categories: professional or academic. The two major postgraduate degrees are the Master of Public Health (M.P.H.) or the Master of Science in Public Health (MSPH). Doctoral studies in this field include Doctor of Public Health (DrPH) and Doctor of Philosophy (Ph.D.) in a subspeciality of greater Public Health disciplines. DrPH is regarded as a professional degree and Ph.D. as more of an academic degree in certain countries. In most curricula encountered in this survey we have seen that the major courses are in Health prevention, health promotion, infectious and non-infectious diseases, chronic diseases, epidemiology, biostatistics, healthcare management. In recent years curricula have been modifies to include now in addition health economics, technology assessment, and ehealth (or health informatics). The most popular in EU countries is to educate public health through the development of Master’s programs in Public Health. The curriculum of such programs are similar to those described above, howver, there is an adaptation of the programs to local needs, for example by including courses related to environment, safety, home care, and telemedicine. It has become evident in recent years that the Bologna process has provided a platform throughout Europe to revisit the educational process and amend traditional academic programs. With that basis a great number of countries within EU and European Universities have developed educational academic and professional programs in Public Health. The majority of them are at a postgraduate level and educate a number of graduates

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

either from medical and health sciences or even from management or other related disciplines. The curricula have included besides the traditional modules eHealth courses, legal principles, management, and healthcare economics and organisation. It is evident, therefore, that in a forthcoming Public Health programme to be developed in Montenegro similar processes have to be developed. The priority should be to develop a Master’s programme in Public Health and the curriculum should include among the modules/courses: health sciences, health promotion, health prevention, infectious and non- infectious diseases, chronic diseases, epidemiology, biostatistics, healthcare management, health economics, technology assessment, and ehealth (or health informatics). The duration should be conforming with the European standards of European Credit Transfer System (90 to 120 ECTS), practice or placement is recommended, and finally the writing up of the dissertation should be mandatory. The selection criteria of the applicants should be transparent and ensure objectivity, the faculty staff should be selected on the principle of academic merit, the accreditation process should ensure the quality of the programme, and the international dimension of the credentiality of the program should be endorsed by the participation within the ERASMUS + Program.

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

References Educational Systems

Wikipedia: Bologna process. https://en.wikipedia.org/wiki/Bologna_Process

The framework of qualifications for the European Higher Education Area. https://media.ehea.info/file/WG_Frameworks_qualification/85/2/Framework_qualificatio nsforEHEA-May2005_587852.pdf http://www.uis.unesco.org/Education/Documents/KS-78-09-653-EN.pdf http://ec.europa.eu/eurostat/statistics-explained/index.php/The_EU_in_the_world_- _education_and_training http://ec.europa.eu/eurostat/statistics-explained/index.php/Tertiary_education_statistics http://ec.europa.eu/eurostat/statistics- explained/index.php/International_Standard_Classification_of_Education_(ISCED) International Public Health Educational Strategies, Best Practices, and Frameworks http://applications.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf http://unesdoc.unesco.org/images/0024/002464/246453e.pdf http://applications.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925808/ http://eagha.g2hp.net/ http://aspher.org/download/21/aspher2020_full-aga2015.pdf http://www.euro.who.int/__data/assets/pdf_file/0011/134300/09E_StrengtheningPublic HealthFramework_110452_eng.pdf Public Health Education in EU Countries

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Austria

Diem G, Dorner TE. Public Health Education in Austria. An overview. 2014. https://www.goinginternational.eu/wp/de/public-health-ausbildung-in-oesterreich-ein- ueberblick

Diem, G. & Dorner, T. Wien Med Wochenschr (2014) 164: 131. doi:10.1007/s10354-014- 0278-9 EURYDICE. Austria – Overview. 2016. https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Austria:Overview Ladurner J, Gerger M, Holland WW et al (eds.). Public Health in Austria – An analysis of the status of public health. Observatory Study Series 24. World Health Organizsation. 2011. http://www.euro.who.int/en/publications/abstracts/public-health-in-austria.-an- analysis-of-the-status-of-public-health-2011 Ministry of Education: Education in Austria 2016/17. https://www.bmb.gv.at/enfr/school/bw_en/bildungswege2016_eng.pdf?5te5kh Ministry for Health and Women (2014). Gesundheitsförderungsstrategie im Rahmen des Bundes-Zielsteuerungsvertrags. http://www.bmgf.gv.at/home/Gesundheitsfoerderungsstrategie World Bank. Public health expenditure. http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS

Belgium

EURYDICE. Belgium – Overview. 2016. https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Belgium-French- Community:Overview Expatica. Education and Schools in Belgium. http://www.expatica.com/be/education/Education-in-Belgium_100088.html Federal public service. Health, food chain safety and environment. Regulated health care professionals in Belgium. https://www.health.belgium.be/en/health/taking-care- yourself/patient-related-themes/cross-border-health-care/healthcare-providers-0

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Nehap Belgium. Health & Environment. ‘Environmental medicine’ training for doctors in the making. http://www.nehap.be/en/news/environmental-medicine-training-doctors- making Trading Economics. Belgium – Public spending on education. http://www.tradingeconomics.com/belgium/public-spending-on-education-total-percent- of-gdp-wb-data.htm World Bank. Public health expenditure. http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS Cyprus https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Cyprus:Redirect https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Cyprus:Higher_Education https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Cyprus:Adult_Education_ and_Training http://www.euro.who.int/__data/assets/pdf_file/0017/174041/Health-Systems-in- Transition_Cyprus_Health-system-review.pdf https://www.ucy.ac.cy/erc/documents/Andreou_Full_Text.010.pdf http://ec.europa.eu/eurostat/statistics- explained/index.php/Healthcare_expenditure_statistics#Healthcare_expenditure_by_functi on http://www.jhsph.edu/about/what-is-public-health/index.html https://www.publichealth.pitt.edu/careers/what-is-public-health https://www.apha.org/what-is-public-health https://www.healthcarestudies.com/Masters-Degree/Health-Sciences/Public- Health/Cyprus/ http://www.mastersportal.eu/search/#q=ci-5|di-90|lv- master,preparation&start=0&length=10&order=relevance&direction=desc

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

http://web.cut.ac.cy/cii/#our_programs https://en.wikipedia.org/wiki/List_of_universities_and_colleges_in_Cyprus http://www.frederick.ac.cy/school-of-education-postgraduate-programs/msc-in-healtheducation-and-health-promotion http://www.frederick.ac.cy/msc-in-community-health-care-program-profile https://www.med.unic.ac.cy/education/msc-family-medicine/ https://www.unic.ac.cy/schools/school-sciences-and-engineering/department-life-health- sciences/contemporary-nursing http://www.nup.ac.cy/objective-of-the-hcm-programme-distance-learning/ http://www.nup.ac.cy/courses/management-of-public-health-care/ http://www.euc.ac.cy/easyconsole.cfm/id/176/dep/168/program_id/68 http://www.euc.ac.cy/easyconsole.cfm/id/176/dep/168/program_id/76/lang/en

Czech Republic

Bencko V. The public health service in the Czech and Slovak Republics celebrates its 60th anniversary. Cent Eur J Public Health. 2013 Mar;21(1):59-60. EURYDICE. Czech – Overview. 2016. https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Czech- Republic:Overview European Observatory on Health Systems and Policies. The Health System and Policy Monitor. Health Systems in Transition (HiT) profile of Czech Republic: http://www.euro.who.int/__data/assets/pdf_file/0005/280706/Czech-HiT.pdf?ua=1 Institute for Postgraduate Medical Education. https://www.ipvz.cz/lekari-zubni-lekari- farmaceuti/ziskavani-specializace/jak-ziskat-specializovanou-zpusobilost

National Institute of Public Health. http://www.szu.cz/index.php?lang=2

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

OECD. Educational Policy Outlook: Czech Republic. June 2013. http://www.oecd.org/czech/EDUCATION%20POLICY%20OUTLOOK%20CZECH%20REPU BLIC_EN.pdf Trading Economics. Czech Republic – Public spending on education. http://www.tradingeconomics.com/czech-republic/public-spending-on-education-total- percent-of-gdp-wb-data.html World Bank. Public health expenditure. http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS Denmark

The Danish education system:http://hfc.dk/media/252204/the_danish_education_system_pdfa.pdf Graduate programme in Public Health and Epidemiology: http://phd-pubhealthepi.ku.dk/

School of Global Health: http://globalhealth.ku.dk/about/purpose_and_goals/ ShortCoursesPortal: http://www.shortcoursesportal.com/search/#q=ci-6|di-90|lv- short&start=0&length=10&order=relevance&direction=desc Denmark’s strategy for lifelong learning: https://www.google.de/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&ved=0ahUKEwjk6 __Lj_LTAhXIECwKHYxfBmsQFgg_MAQ&url=http%3A%2F%2Feng.uvm.dk%2F- %2Fmedia%2Ffiler%2Fuvm%2Fenglish%2Fpdf%2F100324-lifelong- learning.pdf%3Fla%3Den&usg=AFQjCNFpTULR_EgCaKhDGKtw5uCWNbjqcw&sig2=3Pd30 Obsj8UxvdDQGEQlGw Educational expenditure statistics: http://ec.europa.eu/eurostat/statistics- explained/index.php/Educational_expenditure_statistics#Expenditure_of_educational_insti tutions

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Online Certificate of Public Health Programs: https://www.gradschools.com/certificate/public-health/online?countries=denmark

Estonia

Estonian Educational System: http://www.tlu.ee/en/studies/Practical-Information/Estonian-Educational-System Public health in Estonia 2008 - An analysis of public health operations, services and activities: http://ee.euro.who.int/Public%20health%20in%20Estonia%20E92578.pdf E-health in practice – Estonia: http://www.euro.who.int/en/countries/estonia/news/news/016/03/e-health-in-practice

Study programmes at Estonian higher education institutions: http://ekka.archimedes.ee/en/korgkoolide-oppekavad-eng/ WHO – Health Systems in Transition. Estonia – Health system review: http://www.euro.who.int/__data/assets/pdf_file/0018/231516/HiT-Estonia.pdf Germany

World Education News & Reviews – Education in Germany:http://wenr.wes.org/2016/11/education-in-germany Public Health in Germany: http://www.leopoldina.org/uploads/tx_leopublication/2015_Public_Health_LF_EN_01.pdf Global health education in Germany: an analysis of current capacity, needs and barriers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5123271/pdf/12909_2016_Article_814. pdf

Course in Public Health at University of Bielefeld: https://www.uni-bielefeld.de/gesundhw/ag2/summerschoolide/loc_enrol.html Lifelong learning in Germany: https://www.bibb.de/en/18422.php

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Education in Germany 2014: https://www.bmbf.de/en/education-in-germany-2014-1417.html

LRSMed: Learning Resource Server Medicine: http://www.lrsmed.de/index.xsql?menu_id=1&lang=en

Center for Technology-Enhanced Learning: http://www.zml.kit.edu/english/index.php Germany - Public spending on education: (4.11) https://www.indexmundi.com/facts/germany/public-spending-on-education Greece http://www.jhsph.edu/about/what-is-public-health/index.html https://www.publichealth.pitt.edu/careers/what-is-public-health https://www.apha.org/what-is-public-health https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Greece:Redirect#Structu re_of_the_national_education_system https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Greece:Higher_Education https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Greece:Types_of_Higher_ Education_Institutions https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Greece:First_Cycle_Progr ammes http://www.euro.who.int/__data/assets/pdf_file/0004/130729/e94660.pdf?ua=1 http://grammateia.med.uoa.gr/new/viewtopic.php?f=135&t=3689 http://www.nsph.gr/?page=home&lang=EN http://www.nurs.uoa.gr/metaptyxiakes-spoydes.html http://www.publichealth.med.upatras.gr/node/45 http://mph.med.uoc.gr/ | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

http://www.teiath.gr/seyp/health_visit/?lang=en http://www.teiath.gr/seyp/public_health/?lang=en http://healthpromotion.med.uoa.gr/?page_id=109 http://grammateia.med.uoa.gr/new/viewtopic.php?f=138&t=5212 http://grammateia.med.uoa.gr/new/viewtopic.php?f=155&t=4101 Hungary

Ádány, R., Villerusa, A., Bislimovska, J. et al. Public Health Rev (2011) 33: 105. doi:10.1007/BF03391623 http://www.nk.unideb.hu/en/training-programmes http://www.mastersportal.eu/studies/12797/public-health.html http://semmelweis.hu/english/education/academic-programmes/bachelors- programmes/ http://felveteli.pte.hu/kepzesi_kat2

Ireland

Department of Education and Skills. Higher Education in Ireland. http://www.education.ie/en/The-Education-System/Higher-Education/ EURYDICE. Ireland – Overview. 2016. https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Ireland:Overview Health Service Executive. http://www.hse.ie/eng/services/list/5/publichealth/publichealthdepts/about/ Healthy Ireland. A framework for improved health and wellbeing 2013 – 2015. http://health.gov.ie/wp-content/uploads/2014/03/HealthyIrelandBrochureWA2.pdf Medical Careers in Ireland. Public Health Medicine. http://www.medicalcareers.ie/public- health-medicine/

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

OECD. Educational Policy Outlook: Ireland. June 2013. http://www.oecd.org/ireland/EDUCATION%20POLICY%20OUTLOOK%20IRELAND_EN.p df Royal College of Physicians in Ireland. Higher Specialist Training in Public Health Medicine. https://www.rcpi.ie/training/higher-specialist-training/public-health-medicine/

World Bank. Public health expenditure. http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS

Italy https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Overview https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Primary_Education https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Organisation_of_Pri mary_Education https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Secondary_and_Post -Secondary_Non-Tertiary_Education https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Higher_Education https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Types_of_Higher_Ed ucation_Institutions https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Second_Cycle_Progr ammes https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Programmes_outsid e_the_Bachelor_and_Master_Structure https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Early_Childhood_Ed ucation_and_Care https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Primary_Education https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Third_Cycle_(PhD)_ Programmes

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Italy:Adult_Education_an d_Training http://www.euro.who.int/__data/assets/pdf_file/0012/103215/E88550.pdf?ua=1 http://www.euro.who.int/__data/assets/pdf_file/0003/263253/HiT-Italy.pdf?ua=1 http://www.euro.who.int/__data/assets/pdf_file/0003/263253/HiT-Italy.pdf?ua=1 http://www.euro.who.int/__data/assets/pdf_file/0012/103215/E88550.pdf?ua=1 http://www.euro.who.int/__data/assets/pdf_file/0003/263253/HiT-Italy.pdf?ua=1 http://www.mastersportal.eu/studies/155408/physical-activity-and-healthpromotion.html http://www.mastersportal.eu/studies/120973/science-and-technology-for-population- health-and-wealth.html http://www.mastersportal.eu/studies/33145/occupational-safety-and- health.html#content:description http://www.mastersportal.eu/studies/150305/biology-curriculum-biodiversity-and- environmental-health.html http://www.unimi.it/ENG/courses/31180.htm#c92318 http://en.uniroma1.it/node/12786 http://www.univr.it/main?ent=offerta&aa=2017%2F2018&cs=634&lang=en Latvia http://www.ibe.unesco.org/National_Reports/ICE_2008/latvia_NR08.pdf http://www.who.int/fctc/reporting/party_reports/latvia_annex2_public_health_strategy_2 011_2017.pdf https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/images/2/24/Compulsory_Educatio n_in_Europe_2016_2017.pdf http://www.studyinlatvia.eu/en/studies/education-system | PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

"Latvia". Findings on the Worst Forms of Child Labor (2001). Bureau of International Labor Affairs, U.S. Department of Labor (2002).

Global flow of tertiary-level students UNESCO Institute for Statistics http://www.ibe.unesco.org/National_Reports/ICE_2008/latvia_NR08.pdf

Ministry of Education and Science Information on education in Latvia, OECD http://www.who.int/fctc/reporting/party_reports/latvia_annex2_public_health_strategy_2 011_2017.pdf Lithuania http://ec.europa.eu/europe2020/pdf/csr2016/nrp2016_lithuania_en.pdf https://www.oecd.org/edu/school/Lithuania%20-%20Summary%20-%20ENG.pdf

Lithuanian Departament of Statistics "Lithuania". Findings on the Worst Forms of Child Labor (2001). Bureau of International Labor Affairs, U.S. Department of Labor (2002). This article incorporates text from this source, which is in the public domain.

"World Data on Education: Lithuania" (PDF). UNESCO-IBE. 2011. Retrieved 24 June 2014. "Vocational Education in Lithuania". UNESCO-UNEVOC. January 2014. Retrieved 24 June 2014. "Education in Lithuania" (PDF). Ministry of Education and Science of the republic of Lithuania. 2004. Retrieved 24 June 2014.

Ministry of Education and Science, Lithuania

Center for Quality assessment in Higher Education, Lithuania

World Data on Education: Lithuania, UNESCO-IBE(2010) - Overview of the education system

Vocational Education in Lithuania, UNESCO-UNEVOC(2014) - Overview of the vocational education system https://www.oecd.org/edu/school/Lithuania%20-%20Summary%20-%20ENG.pdf

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

http://ec.europa.eu/europe2020/pdf/csr2016/nrp2016_lithuania_en.pdf

Luxemburg https://www.oecd.org/edu/school/Lithuania%20-%20Summary%20-%20ENG.pdf https://www.oecd.org/luxembourg/Education-Policy-Outlook-Country-Profile- Luxembourg.pdf page 4 http://www.lifelong-learning.lu/Accueil/en http://ec.europa.eu/europe2020/pdf/csr2016/nrp2016_luxembourg_en.pdf Institute of Health in Luxembourg can be accessed at: https://www.lih.lu/

Department of Population Health, for more information, visit the following link: https://www.lih.lu/jobs/department/doph-department-of-population-health-779 https://www.oecd.org/luxembourg/Education-Policy-Outlook-Country-Profile- Luxembourg.pdf page 6 https://www.oecd.org/luxembourg/Education-Policy-Outlook-Country-Profile- Luxembourg.pdf http://www.lifelong-learning.lu/Accueil/en http://ec.europa.eu/europe2020/pdf/csr2016/nrp2016_luxembourg_en.pdf

Malta http://www.euro.who.int/__data/assets/pdf_file/0010/241849/HiT-Malta.pdf, page 21 Undergraduate study-unit in Public Health: https://www.um.edu.mt/ms/publichealth/courses Master in Science in Public Health at University of Malta (for detailed overview): http://www.um.edu.mt/ms/programme/PMMSCPHLFTR5-2015-6-O Postgraduate Courses offered by the Health Services Management Department at University of Malta http://www.um.edu.mt/courses/list.php

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

National Statistics Office of Malta. News Release for January –March, 2017: Government Finance Data. Published on 28 April 2017. Accessed on 30 April, 2017 at: https://nso.gov.mt/en/News_Releases/View_by_Unit/Unit_A2/Public_Finance/Documents /2017/News2017_074.pdf http://www.euro.who.int/__data/assets/pdf_file/0010/241849/HiT-Malta.pdf, page 21 Undergraduate study-unit in Public Health: https://www.um.edu.mt/ms/publichealth/courses Master in Science in Public Health at University of Malta (for detailed overview): http://www.um.edu.mt/ms/programme/PMMSCPHLFTR5-2015-6-O

Postgraduate Courses offered by the Health Services Management Department at University of Malta http://www.um.edu.mt/courses/list.php

Life-long learning in Malta: https://www.gov.mt/en/services-and-information/business- areas/education%20and%20learning/pages/lifelong-learning.aspx https://education.gov.mt/en/resources/Documents/Policy%20Documents%202014/BOO KLET%20ESM%202014-2024%20ENG%2019-02.pdf National Statistics Office of Malta. News Release for January –March, 2017: Government Finance Data. Published on 28 April 2017. Accessed on 30 April, 2017 at: https://nso.gov.mt/en/News_Releases/View_by_Unit/Unit_A2/Public_Finance/Documents /2017/News2017_074.pdf Netherlands

The Dutch education system described: https://www.nuffic.nl/en/publications/find-a-publication/education-system-the- netherlands.pdf

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Erasmus MC – Netherlands Institute for Health Sciences (Public Health): http://www.nihes.com/research/departments/public-health/

CEDEFOP – The Netherlands in the European top five for livelong learning: http://www.cedefop.europa.eu/de/news-and-press/news/netherlands-european-top- five-lifelong-learning https://www.cbs.nl/en-gb/news/2016/07/the-netherlands-in-european-top-5-of-lifelong- learning- Collaborative organisation for ICT in Dutch education and research: https://www.surf.nl/en https://www.surf.nl/en/about-surf/mission-and-vision/surfs-strategic-plan/index.html Netherlands – Distance Learning Degrees: http://www.distancelearningportal.com/search/#q=ci-1|di-90|mh- online&start=0&length=10&order=relevance&direction=desc Healthcare in the Netherlands (Ministry of Health, Welfare and Sport) 2015: https://investinholland.com/nfia_media/2015/05/healthcare-in-the-netherlands.pdf Netherlands - Educational expenditure - Public expenditure on education as a percentage of total public expenditure: http://knoema.de/atlas/Niederlande/topics/Bildung/Bildungsausgaben/%C3%96ffentlic hen-Bildungsausgaben WHO - Health Systems in Transition (Netherlands - Health system review): http://www.euro.who.int/__data/assets/pdf_file/0016/314404/HIT_Netherlands.pdf Poland

Invest in Wroclaw – Education system in Poland: http://www.invest-in- wroclaw.pl/en/key-data/education-and-knowledge/education/ Institute of Public Health, Jagiellonian University Medical College, Krakow: http://www.hpm.org/en/Surveys/Jagiellonian_University_-_Poland.html Ministry of Science and Higher Education – Poland (Higher Education Institutions):http://www.go-poland.pl/higher-education-institutions

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

OECD - EDUCATION POLICY OUTLOOK POLAND: http://www.oecd.org/edu/POL-country- profile.pdf

The Institute of Public Health – Jagiellonian University: http://www.izp.wnz.cm.uj.edu.pl/en_GB/education/full-time-courses http://www.izp.wnz.cm.uj.edu.pl/education/europubhealth-studies

E-LEARNING in Poland:http://s3.amazonaws.com/zanran_storage/www.easy- elearning.net/ContentPages/48100643.pdf European Association For The Education Of Adults (Country Report on Adult Education in Poland) 2011: http://www.eaea.org/media/resources/ae-in-europe/poland_country- report-on-adult-education-in-poland.pdf WHO - The health system and policy monitor (Poland): http://www.who.int/health- laws/countries/pol-en.pdf

Portugal https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Portugal:Overview https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Portugal:Adult_Educatio n_and_Training_Funding https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Portugal:Redirect https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Portugal:Early_Childhoo d_Education_and_Care https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Portugal:Upper_Secondar y_and_Post-Secondary_Non-Tertiary_Education https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Portugal:Higher_Educati on https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Portugal:Types_of_Highe r_Education_Institutions https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Portugal:First_Cycle_Pro grammes

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Portugal:Second_Cycle_P rogrammes https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Portugal:Programmes_ou tside_the_Bachelor_and_Master_Structure https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/Portugal:Third_Cycle_(Ph D)_Programmes https://web.archive.org/web/20090225002655/http://www.euro.who.int/document/ch h/por_highlights.pdf http://www.euro.who.int/__data/assets/pdf_file/0019/150463/e95712.pdf http://www.mastersportal.eu/search/#q=ci-21|di-90|lv- master,preparation&start=0&length=10&order=relevance&direction=desc https://www.healthcarestudies.com/Masters-Degree/Health-Sciences/Public- Health/Portugal/ http://www.ihmt.unl.pt/mestrados-doutoramentos-candidaturas-abertas/ http://www.phd-gph.ensp.unl.pt/partners/ https://www.ulisboa.pt/en/inicio/study/programmes/bachelors-degree-1st-cycle/ https://www.ulisboa.pt/en/inicio/study/programmes/masters-degree-2nd-cycle/ https://apps.uc.pt/courses/EN/course/6601 https://apps.uc.pt/courses/EN/course/6181 https://sigarra.up.pt/fmup/en/cur_geral.cur_view?pv_ano_lectivo=2014&pv_origem=CUR &pv_tipo_cur_sigla=M&pv_curso_id=1115 https://sigarra.up.pt/fmup/en/cur_geral.cur_view?pv_ano_lectivo=2014&pv_origem=CUR &pv_tipo_cur_sigla=M&pv_curso_id=1136 https://sigarra.up.pt/fmup/en/cur_geral.cur_view?pv_ano_lectivo=2014&pv_origem=CUR &pv_tipo_cur_sigla=M&pv_curso_id=1170

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

http://ispup.up.pt/academics/msc-programmes/ http://www.envihealth-phd.com/ http://ispup.up.pt/academics/phd-programmes/ https://sigarra.up.pt/fmup/en/cur_geral.cur_view?pv_origem=CAND&pv_curso_id=1170 https://sigarra.up.pt/icbas/en/cur_geral.cur_view?pv_origem=CAND&pv_curso_id=1136 https://sigarra.up.pt/feup/en/cur_geral.cur_view?pv_origem=CAND&pv_curso_id=639 https://sigarra.up.pt/fmup/en/cur_geral.cur_view?pv_origem=CAND&pv_curso_id=11101 https://sigarra.up.pt/fmup/en/cur_geral.cur_view?pv_origem=CAND&pv_curso_id=1182 https://sigarra.up.pt/fmup/en/cur_geral.cur_view?pv_origem=CAND&pv_curso_id=1202 http://www.dges.mec.pt/guias/detcursopi.asp?codc=9861&code=7210&frame=1&lang=e ng http://www.dges.mec.pt/guias/detcursopi.asp?codc=9822&code=1500&frame=1&lang=e ng http://www.dges.mec.pt/guias/detcursopi.asp?codc=9822&code=4260&frame=1&lang=e ng http://www.dges.mec.pt/guias/detcursopi.asp?codc=L084&code=3138&frame=1&lang=e ng http://www.dges.mec.pt/guias/detcursopi.asp?codc=9550&code=2800&frame=1&lang=e ng http://www.dges.mec.pt/guias/detcursopi.asp?codc=9861&code=7230&frame=1&lang=e ng http://www.dges.mec.pt/guias/detcursopi.asp?codc=9861&code=7230&frame=1&lang=e ng http://www.studyinportugal.edu.pt/index.php/courses/2nd-cycle http://www.studyinportugal.edu.pt/index.php/courses/3rd-cycle

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

Romania http://www.euroeducation.net/prof/romco.htm

Cristian Vladescu, Silvia Gabriela Scîntee, Victor Olsavszky, Cristina Hernández-Quevedo, Anna Sagan, Romania Health system review, Health Systems in Transition, Vol. 18 No. 4 2016 (Europian observatory on helth system and policies- a partnership Hosted by WHO) UNESCO Institute for Statistics available at: http://databank.worldbank.org/data Vlãdescu C, Scîntee SG, Olsavszky V, Hernández-Quevedo C, Sagan A. Romania: Health system review. Health Systems in Transition, 2016; 18(4):1–170. pp 91-92, available at: http://www.healthobservatory.eu http://www.slovak-republic.org/education/ http://www.euroeducation.net/prof/slovakco.htm http://www.euroeducation.net/prof/slovakco.htm

The Ministry of Education, Science, Research and Sport of the Slovak Republic, https://www.minedu.sk/ and Study in Slovakia, http://office.studyin.sk/entering- slovakia/foreign-applicants.html Study in Europe, http://www.study-europe.net/countries/slovakia

Zuzana Chudackova, Iva Hulmanova, Accessibillity to Health Care in Slovakia, Journal of the International Institute for Law and Medicine, 2015, pg. 43-60. UNESCO Institute for Statistics available at: http://databank.worldbank.org/data

Smatana M, Pažitný P, Kandilaki D, Laktišová M, Sedláková D, Palušková M, van Ginneken E, Spranger A (2016). Slovakia: Health system review. Health Systems in Transition, 2016; 18(6):1–210, pp.27, available at: http://www.healthobservatory.eu

Slovakia

Vlãdescu C, Scîntee SG, Olsavszky V, Hernández-Quevedo C, Sagan A. Romania: Health system review. Health Systems in Transition, 2016; 18(4):1–170. pp 91-92, available at: http://www.healthobservatory.eu

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

http://www.slovak-republic.org/education/ http://www.euroeducation.net/prof/slovakco.htm http://www.euroeducation.net/prof/slovakco.htm

Sources: The Ministry of Education, Science, Research and Sport of the Slovak Republic, https://www.minedu.sk/and Study in Slovakia, http://office.studyin.sk/entering- slovakia/foreign-applicants.html

Study in Europe, http://www.study-europe.net/countries/slovakia Zuzana Chudackova, Iva Hulmanova, Accessibillity to Health Care in Slovakia, Journal of the International Institute for Law and Medicine, 2015, pg. 43-60. UNESCO Institute for Statistics available at: http://databank.worldbank.org/data Smatana M, Pažitný P, Kandilaki D, Laktišová M, Sedláková D, Palušková M, van Ginneken E, Spranger A (2016). Slovakia: Health system review. Health Systems in Transition, 2016; 18(6):1–210, pp.27, available at: http://www.healthobservatory.eu Sweden

The European Education Directory – Sweden: http://www.euroeducation.net/prof/swedco.htm

WHO – Health Laws (Sweden): http://www.who.int/health-laws/countries/swe- en.pdf?ua=1 Study Programmes in Sweden: https://studyinsweden.se/programmes/?query=Public+Health&period=ht- 2017&level=&subject=&university=#search

The Swedish Research School for Global Health: http://www.sweglobe.net/courses.htm CEDEFOP - Lifelong learning in Sweden:http://www.cedefop.europa.eu/en/publications- and-resources/publications/5112

A Comparative Analysis of Higher Education in the US and Sweden: http://www.heybradfords.com/mo2/files/CV/DoctoralCourseFiles/Swe-US_OnlineEd- comparative_r1.pdf

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

OECD – Education at a glance (Sweden): https://www.oecd.org/edu/Sweden-EAG2014- Country-Note.pdf

Higher Education System in Sweden: http://www.su.se/english/education/courses/higher-education-system/higher- education-system-in-sweden-1.166324

United Kingdom

Education System in the UK. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/219167 /v01-2012ukes.pdf EURYDICE. United Kingdom (England) – Overview. 2016. https://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php/United-Kingdom- England:Overview General Medical Council. GMC Gives Green Light to ‘Passport to Practise’; Press Release 26th September 2014. http://www.gmc-uk.org/news/25493.asp(8 October 2014, date last accessed). Higher Education Funding Council for England (HEFCE). http://www.hefce.ac.uk/

OECD. Education Policy Outlook United Kingdom. http://www.oecd.org/edu/UKM_profile_final%20draft_EN.pdf Stephen Gillam, Veena Rodrigues, Puja Myles. J Public Health (Oxf) (2016) 38 (3): 522-525.

Trading Economics. United Kingdom– Public spending on education. http://www.tradingeconomics.com/united-kingdom/public-spending-on-education-total- percent-of-gdp-wb-data.html

World Bank. Public health expenditure. http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS Public Health Education Best Practices in other Countries Canada http://www.studycountry.com/guide/CA-education.htm

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

http://www.studycanada.ca/english/education_system_canada.htm http://www.studycountry.com/guide/CA-education.htm

The Canadian Magazine of Immigration, http://canadaimmigrants.com/canada- international-students-by-country-2015/

Justice Laws Website, http://laws-lois.justice.gc.ca/eng/regulations/SOR-93-392/page- 1.html#docCont http://www.ciphi.ca/careers/board-of-certification/ UNESCO Institute for Statistics available at: http://databank.worldbank.org/data

Japan

Gregory P. Marchildon. Canada: Health system review. Health Systems in Transition, 2013; 15(1): 1 – 179, pp. 95 http://japan.ahk.de/en/japan-info/customs-culture/education-system/ http://www.japaneducation.info/Higher-Education/index.html http://www.g-studyinjapan.jasso.go.jp/en/modules/pico/index.php?content_id=11

Tatara K, Okamoto E. Japan: Health system review. Health Systems in Transition, 2009; 11(5): 1–164. pp.93 IBID. pp.92 http://www.japaneselawtranslation.go.jp/ UNESCO Institute for Statistics available at: http://databank.worldbank.org/data

Kozu, T. “Medical Education in Japan”, Acad Med. 2006 Dec;81(12):1069-75. pp.1069. USA https://ceph.org/accredited/ https://www.hsph.harvard.edu/history-of-the-school/

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro

http://rockefeller100.org/exhibits/show/education/medical-education/public-health-at- johns-hopkins https://educationusa.state.gov/your-5-steps-us-study/research-your- options/graduate/graduate-student/what-graduate-programs-a-9 https://www.usnews.com/best-graduate-schools/top-health-schools/public-health- rankings http://www.healthcare-management-degree.net/best/graduate-degree-in-public-health/ http://www.aspph.org/about/ https://ceph.org/accredited/search/

| PROJECT COORDINATOR: University of Donja Gorica European Commission Erasmus+ Project: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP | Donja Gorica, 81 000 Podgorica, Montenegro