5. Provision of services
- All publicly financed health services are free of charge at the point of use for persons entitled to statutory provision.
- Primary and ambulatory care is readily available through the public and private sectors.
- Secondary and tertiary care is provided mainly through public hospitals. The main acute general hospital (MDH) caters for the bulk of emergency care.
- The private sector accounts for about two-thirds of the workload in primary care and is remunerated on a fee-for-service basis. Many people choose to access primary care services in the private sector because it offers better continuity of care.
- Long-term care for older people is provided by the state, the Church and the private sector, and also through partnerships between the state and the private sector.
- Publicly provided dental care is free at the point of use for certain population groups, including children, while in the private sector payment is usually made out of pocket.
5.1 Public health
The main entity responsible for public health is the Public Health Regulation Department within the Ministry for Health. This Department was established under the Health Act. Its powers are also derived through other Acts such as the Public Health Act. Specific public health functions are administered by the following organizations.
The Infectious Disease Prevention and Control Unit is responsible for the surveillance and management of infectious diseases. It also provides data on infectious diseases to the local and international scientific community, as well as advice to health workers and the general public.
The Health Promotion and Disease Prevention Directorate conducts campaigns to promote healthy lifestyles and to provide information and support services related to healthy living. This Directorate played a crucial role in the launch of the Healthy Weight for Life Strategy in 2012, the Food and Nutrition Action Plan in 2014, and the Mediterranean Diet campaign in 2016. It was also responsible for the release of a number of strategies addressing major risk factors over the past decade, for example, the Non-Communicable Disease Strategy launched in 2010.
The National Immunization Service within the Primary Care Services division of the Ministry for Health offers free scheduled immunizations to children, vaccinations for employees at risk of particular diseases and for international travellers, as well as vaccinations against tuberculosis and hepatitis B. Influenza vaccination is offered to older people, those with chronic illness and health care staff.
The Environmental Health Directorate deals with environmental issues that affect health and well-being. The Directorate covers health inspectorate services (including food safety and hygiene), public health laboratories, port medical services and a policy coordinating unit. The national entity responsible for occupational health and safety is the Occupational Health and Safety Authority (OHSA) established by the OHSA Act XXVII of 2000.
The Directorate for Health Information and Research (DHIR) supports all public health services and clinical services through data collection and epidemiological research initiatives. It is responsible for data collection to maintain disease registers, monitor hospital activity and disseminate data about population health and health services.
The National Health Screening Services Malta administers the National Cancer Screening Register for the Maltese Islands for breast, colorectal and cervical cancer screening. These plans were implemented following the launch of the first National Cancer Plan in 2011. Another screening programme offered through primary health centres targets glaucoma.
The Sedqa agency has offered health promotion, disease prevention, treatment and rehabilitation services to persons with drug, alcohol and/or compulsive gambling problems, and to their families since 1994, and is part of the Foundation for Social Welfare Services within the Ministry for the Family and Social Solidarity.
Box5.1 provides the assessment of the effectiveness of public health interventions.
By 2025, the Ministry for Health envisions that the transmission of Hepatitis C Virus (HCV) will be halted in Malta and that people living with HCV will have access to safe, affordable and effective prevention, testing, care and treatment. This strategy, launched in 2018, was prepared following the signing of the São Paulo Declaration on Viral Hepatitis at the World Hepatitis Summit 2017, committing Malta to meet WHO’s elimination targets.
The strategy describes a comprehensive, integrated and multisectoral approach encompassing four major areas: prevention, screening and diagnosis, treatment, and monitoring and governance. The main investment is in the Direct-Acting Antiviral therapy which has now been included in the Government Formulary List and is thus freely available to those entitled to free health care within the health system. This is complemented by other public health measures to ensure a steady decline in prevalence and incidence, focussing on targeted populations. To ensure implementation, all actions will be monitored and reviewed regularly.