HPH Progress Report 2017-2018: Estonia 




The HPH Constitution (2008) for the International Network of Health Promoting Hospitals and Health Services states that one of the tasks of a National/Regional HPH Network is: “To periodically deliver a progress report to the Governance Board.” (Refer to 1.4. Mission and Obligations, HPH Constitution)


For the purposes of this activity:


  • The period for progress reports to be delivered is every two years.

  • A progress report is defined as a report on efforts to assist hospitals/health services to ”incorporate the concepts, values, strategies and standards or indicators of health promotion into the organizational structure and culture of the hospital/health service." (Refer to Mission, HPH Constitution)


The aims of Progress Reports are:

  1. To provide a mechanism for HPH networks and taskforces to share information, knowledge and experience

  2. To contribute to an assessment of the achievement of objectives by the International HPH Network

  3. To help identify priorities for future action by the International HPH Network.

This survey refers to activities in the period 2017-2018.


All data will be made publicly available.



INSTRUCTIONS: Keep the text that in black color. Change the text in grey colour (Green text is hyperlinks for your reference)





Part 1: Administrative information



1A. Network contact details

  • Network Coordinator name: Tiiu Härm (2000 - 2016), Kaja Põlluste (from 01.01.2017)

  • Phone: +372 7318 616 (Kaja Põlluste)

  • E-mail:

  • Address:L. Puusepa 8, Tartu, ESTONIA

  • Website: -

  • Name of Coordinating Institution: University of Tartu, Institute of Clinical Medicine

  • Address: L. Puusepa 8, 50406 Tartu, Estonia

  • E-mail (If different from coordinator’s):

  • Phone (If different from coordinator’s):

  • Institution Website:


1B. Network administrative details

  • Network establishment: 10/01/2000

  • Expiration of network agreement: 10/03/2000

  • Number of current Network members: 9

  • My list of members on is up to date: no

  • Number of new members in 2017: 0

  • Number of new members in 2018: 0

  • Number of ceased members in 2017: 1

  • Number of ceased members in 2018: 12





Part 2: Network progress



2A. To what degree has my network put the HPH mission, purpose and objectives into practice?


  1. Choose one option

  • Not at all

  • A little bit

  • Moderate

  • Quite a lot

  • Completely

Please elaborate here:

Since 2000, a lot of HPH activities have been introduced in the hospitals belonging to the HPH network. The main achievements are as follows:

•Involvement and good cooperation at the national level

•Implementation of clinical health promotion with the focus on quality, patient safety and staff’s wellbeing

•Implementation of HPH standards and strategies; integration of HP and quality management in hospitals

•Development of the HP centres within the HP hospitals (14 tobacco cessation clinics, 6 mental health centres, 5 clinical departments for the patients with alcohol disorders)


Main activities since 2000:

•Exchange of knowledge and experience (15 national HPH conferences and 11 national summer schools, participation in 20 international conferences and in 3 international  summer schools)

•Participation in international HPH task forces (Health Promotion for Children and Adolescents in and by Hospitals; Age -friendly Health Care; Tobacco -free Healthcare Service, incl preoperative smoking cessation and smoke-free maternity; Health Promotion in Mental Health Settings)

• Participation in international HPH projects (PRICE Project, HPH Data Project, WHO-HPH Recognition Project)

• Participation in Global Network for Tobacco-free Healthcare Services (ENSH-Global)



2B. How is my network organized and how do we work?


The previous coordinating institution - National Institute for Health Development - decided to finish the coordination and financing of the HPH Network by the end of 2016. Since 2017, the coordination was taken over by the Institute of Clinical Medicine, University of Tartu with the presumption that the hospitals were ready to continue the financing of the network activities from their own resources. However, in reality this did not happen, and majority of hospitals left the network. So, today the Estonian HPH Network is not really existing anymore. Still, the communication between the hospitals has continued and will continue in the future as well, ainly through the networking of hospitals (this means not only the networking HPH activities, but all other activities as well).


2C. What has been the aim of my network?


in general, the Estonian HPH network never had the fprmal strategy with clear formulation of aims and objectives, still, the general common aim has been to introduce the ideology of health promotion in the hospitals' everuday work through the very various activities, and this aim has been achieved.



2D. What were my network's main achievements and lessons learned?


The achievements were described above, still, there are no special achievements during 2017-2018 any additional achievements. The HPH work has been conituned, the representatives of the hospitals participated in the international HPH conferences in 2017 and 2018.


Still, the main lesson from my point of view is that regardless of outstanding achievements before 2017 and international recognition, the network and its achievements have been understood and recognised in hospitals, but not enough on the governmental level (Ministry of Social Affairs). Unfortunately, the lack of the long-term strategy for the national HPH network with clearly formulated objectives and action plans as well the insufficient dissemination and exploitation of the results and achievements in the media and society has certainly been one of the obstackles for the continuation of the financing of these activities. However, we started to formulate the strategy and objectives (which is the inevitable precondition to find the recourses), but this has been not very successful as we have been waiting for the updated WHO-HPH Standards.



2E. Global HPH Strategy 2016-2018


My network worked with the Global Strategy: yes/no


Specifically, priority was given to

  • (Priority 1 on implementation of updated WHO-HPH Standards: NB not applicable due to delay with document)

  • Priority 2 on HPH awareness and capacity: yes/no

  • Priority 3 on HPH development and sustainability: yes/no

My network supported members with fulfilling the Global Strategy: yes/no


My network acheived the following strategy goals

  • Priority 2 on HPH awareness and capacity

A-I) Organised at least 1 local HPH day: yes/no

A-II) Local policy level participated in HPH day: yes/no

A-III) Informed local policy level of HPH: yes/no

B-I) Participated in discussion of the role of coordinators at HPH assembly: yes/no

B-II) Members received the translated/locally adapted final document: yes/no

C) Stakeholder analysis made by network: yes/no

D-I) Members received translated/locally adapted HPH Member Packages: yes/no

D-II) At least 2 local decision makers received translate/locally adapted HPH package: yes/no

E) Own website updated at least 4 times with news, information and experiences: yes/no

F) Best practices/good ideas collected and reported at HPH general assembly, or here in progress report: yes/no

  • Priority 3 on HPH development and sustainability

A-I) Participated in discussion and development of member benefits: yes/no

A-II) Translated/locally adapted HPH brochure describing the benefits of membership received by my members: yes/no

B-I) Hospitals nationally/regionally with potentially interest in HPH were listed: yes/no

B-II) Contact was established and HPH information was sent to at least 2 potential new members: yes/no

C) Best practices/good ideas collected and reported at HPH assembly, or here in Progress Report: yes/no


If you wish to share your experiences in this regard, please feel free to elaborate here:

<you can answer in writing or by, for instance, adding a video presentation here>



2F. How did my network use the WHO-HPH Standards?


My network prioritized working with the standards: yes/no

The previous standards have been implemented already several years ago, so this work continued in 2017-2018 as well. If the updated standards were already available we would be given the priority for the further development to Standards 2 and 3, but also standard 5


If yes, priority was given to

  • Standard 1 on Management policy: yes/no

  • Standard 2 on Patient assessment: yes/no

  • Standard 3 on Patient information and intervention: yes/no

  • Standard 4 on Promoting a healthy workplace: yes/no

  • Standard 5 on Continuity and cooperation: yes/no

My network has supported members with using the standards for quality improvement: yes/no (already several years ago)


The status in my network is that members have implemented

  • Standard 1 on Management policy

1.1. The organization identifies responsibilities for HP: implemented/partly implemented/not implemented

1.2. The organization allocates resources for the implementation of HP: implemented/partly implemented/not implemented

1.3. The organization ensures availability of procedures for HP data collection/evaluation: implemented/partly implemented/not implemented

  • Standard 2 on Patient assessment

2.1. The organization ensures procedures for all patients to assess their need for HP: implemented/partly implemented/not implemented

2.2. The HP needs assessment is done at first contact, reviewed and adjusted: implemented/partly implemented/not implemented

2.3. The HP needs assessment includes external info and is social/cultural sensitive: implemented/partly implemented/not implemented

  • Standard 3 on Patient information and intervention

3.1. Based on needs, patients are informed and HP plan is agreed: implemented/partly implemented/not implemented

3.2. The organization ensures access to general information on factors influencing health: implemented/partly implemented/not implemented

  • Standard 4 on Promoting a healthy workplace (has been implemented alread more than 10 years ago as many of these activities are required by law)

4.1. The organization ensures a healthy and safe workplace: implemented/partly implemented/not implemented

4.2. The organization ensures a HR Strategy that includes HP: implemented/partly implemented/not implemented

4.3. The organization ensures procedures to develop/maintain staff awareness on health: implemented/partly implemented/not implemented

  • Standard 5 on Continuity and cooperation

5.1. The organization ensures HP services are coherent with regional health policy plans: implemented/partly implemented/not implemented

5.2. The organization ensures HP for out-patients and after discharge: implemented/partly implemented/not implemented


If you wish to share your experiences in this regard, please elaborate here:

<you can answer in writing or by, for instance, adding a video presentation here>



2G. Standards developed by HPH Task Forces and other relevant standards


My network has worked with standards from the HPH Task Forces on

  • Equity/migrants: yes/no

  • HPH Children/Adolescents Standards: yes/no

  • Environment: yes/no

  • Age-friendly healthcare: yes/no

My network has worked with other relevant standards: name the standards


If you wish to share your experiences in this regard, please feel free to elaborate here:

<you can answer in writing or by, for instance, adding a video presentation here>








Part 3: Sharing of knowledge and experience



3A. Additional strategy, priorities and focus areas of my network

My network focused on:

provision of patient-centered health care, Currently, in addition to the health promoting activities, a lot of activities are focused on the patient safety.



3B. My network's connection to National/Regional health policies and strategies

  • HPH is a priority nationally/regionally in health policies, laws and regulations: yes/no

  • Changes in national/regional health policies have directly influenced my network's activities: yes/no (this inluence has been rather negative)

  • The national/regional health system is supportive of the development of HPH: yes/no

  • My network has received recognition/acknowledgment from public authorities/health systems: yes/no

If you wish to share your experiences in this regard, please feel free to elaborate here:

<you can answer in writing or by, for instance, adding a video presentation here>



3C. Availability of key HPH documents in my local language


In my local language the following documents exist

In my local language, I would like the following HPH documents to be made available: Vienna Recommendations



3D. My network's untapped resources and needs for further support


My network has untapped resources that could help contribute to the International HPH Network’s fulfilment of its objectives by:

<you can answer in writing or by, for instance, adding a video presentation here>


The International HPH Network, the HPH Governance Board and the HPH Governance Assembly could better support my network by:

<you can answer in writing or by, for instance, adding a video presentation here>



3E. Final comments and ideas


Final comments and ideas from my network are:

It seems that in present situation the Estonian HPH network in its current form has been used up. Based on the last meeting in November 2018 and personal contacts the main problem in most hospitals is the lack of motivation - the health promotion has been quite successfully integrated into everyday clinical practice, and they do not perceive anymore the need for such network activities as it was about 10 years ago. The participation in international network has been very valuable experience, however, today many hospitals cannot see longer the benefit from being a member of international network and left their membership during 2017-2018. In this situation there is very few chances to get support from the national level and re-activate the network activities. For that reason we are in the situation where we probably have to close the network activities in 2019. Estonia is a small country, thus the communication and networking between the hospitals will continue anyway, just in another form. 







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