Directory of European Resources > Eurocleft Clinical Network > Registered Clinical Teams > Estonia

Clinical Teams in ESTONIA

• Tallinn
• Tartu

Population
Approximately 1.4 million.

Health Service
Since becoming independent, Estonia has been changing the basis of its health care system from centralisation and state control to decentralisation and health insurance. The objective is to improve the health of the population through an integrated system that emphasises health promotion, disease prevention and environmental health. Health falls under the remit of the Ministry of Social Affairs with primary and secondary care organised at municipal level individually or jointly by the community or county councils and community physicians.

Up until 2003 insurance funds paid for all health services to patients including ambulatory and hospital care. Since 2003 however, the patients themselves must pay for hospital visits and stays, with exception of patients under 19 years of age. The municipalities own the health services and thus pay the maintenance and running costs of all facilities. They are expected to make all necessary investments in equipment and building as well. In case of financial shortages, the state may make adjustments.

Cleft Care Organisation
Estonia has around 15-20* new cases of cleft lip and/or palate per year. Care is delivered from two centres in the departments of maxillofacial surgery in Tallinn, the capital city, and in Tartu. In both centres a team of multidisciplinary specialists provide complex care. All treatment, including since 1999, the cost of orthodontic appliances, is free. The Eurocleft Consensus Recommendations were adopted in 2001 and surgical / orthodontic staff, have visited the Helsinki cleft centre for training courses. The Estonian Association for Oral and Maxillofacial Surgery was founded in 1991 and currently has around 20 members. Systematic registration of children with clefts began in 1965 and the register is currently undergoing further development. Since 2000 the Tartu centre has been part of the Baltic cleft network which hopes to organise some intercentre studies.

Challenges to Attaining the Eurocleft Consensus Recommendations
Particular challenges which Estonia faces include insufficient financial support especially due to recent healthcare reforms which are, as yet, unfinished and a lack of certain specialisms and specialist training in the cleft team: social workers, specialist nurses and “phoniatric” specialists. There are also social problems including transport difficulties and historically no parent support group. As yet there has been no Estonian participation in intercentre comparisons or clinical trials.

Future Plans
The Ministry of Health has traditionally viewed cleft lip and/or palate as a low priority, however the Eurocleft network is helping to raise the profile of cleft care and to facilitate change. Since June 2003 Estonia has been part of a European surgical cohort study and hopes to participate in an appraisal of the use of distraction osteogenesis in craniofacial disorders.

* Estimated number of clefts per annum reported by the national representative for Estonia