health care reform in serbia health care reform in serbia ivana mišić, md assistant minister june...
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Health Care Reform in Health Care Reform in SerbiaSerbia
Ivana MiIvana Mišićšić, MD, MDAssistant Minister Assistant Minister
June 2June 2ndnd 2008, Halifax, Canada 2008, Halifax, Canada
Demographic profile of Serbia Demographic profile of Serbia (without data for Kosovo and Metohija)(without data for Kosovo and Metohija)
• Population (Census data, 2002): 7 498 001• Population 65 and older: 17.2%• Median age- total, 2005: 40,6 yrs
– Male 39,3– Female 41,8
• Birth rate (2005): 9.7• Crude death rate (2005): 14.3 • Life expectancy at birth (2005)
- male: 70,0• Life expectancy at birth (2005)
- female: 75,4• Total fertility rate (2004): 1,6
SERVICE DELIVERYSERVICE DELIVERYOrganizational structure of the public health system in Organizational structure of the public health system in
SerbiaSerbiaMinistry of Health
Health Insurance Fund
Institute of Public Health of Serbia
Clinical Center of Serbia
Clinical Center
Clinical Hospital Center
Institute
HIF branches
Public health institutes
General Hospital
Primary Health Centre
Health station
Health station
Health station
Health station
Health station
Health station
Health station
Primary Health Centre
Primary Health Centre
HEALTH CENTRE
General HospitalGeneral
HospitalSpecial Hospital
Spec. Institution
PharmacyPharmacy
Primaryhealthcare level
Secondaryhealthcare level
Tertiaryhealthcare level
The right to health care in SerbiaThe right to health care in Serbia
• Every citizen is entitled to health care in the Republic of Serbia
• Citizens realize their right to health care on the basis of a health card
• In order to obtain a health card every citizen has to register his/here place of residence
• In case of emergency health care is provided to all citizens
• The readmission process is currently ongoing (Low number of Roma possess personal documents, high number do not wish to obtain legal status)
Primary health care (PHC) situation in Primary health care (PHC) situation in Serbia at the beginning of the 21Serbia at the beginning of the 21stst
century – a diagnosiscentury – a diagnosis• The PHC practitioner as a “traffic policeman”
having a poorer status compared to practitioner on higher levels of care
• Fragmentary system – jeopardizing the health care continuity
• Overspecialization – a polyclinic approach• Low efficiency and uneven quality of services
provided• Absence of motivation to engage in health
promotion and disease prevention• Non systematic approach in including the
consumers in the PHC policy decision
PHC quality indicators in 2006PHC quality indicators in 2006((Institute of Public Health of SerbiaInstitute of Public Health of Serbia
““Dr Milan JovanoviDr Milan Jovanovicc Batut Batut”)”)
• A well-developed primary health-care institutions network - comprising 158 primary health care centers
• 36% of all doctors work in PHC;• General practitioners make up 17% of the total number of
doctors;• Population coverage with PHC doctors reveals a ratio of
1049 people to one doctor;• Population coverage with GPs reveals a ratio of 1149
adult citizens (over 19) to one doctor;• Average use of the general practice service is 6
consultations per capita
Strategies of the Republic of Serbia Strategies of the Republic of Serbia related to healthrelated to health
MoH participated in MoH participated in strategy papers strategy papers development:development:
1. Poverty reduction strategy paper (2003)
2. Plan of action for children (2004)
3. Action plan for health of Roma population (2005)
4. Strategy of aging (2005)
MoH initiated strategy papers MoH initiated strategy papers development and development and Government acceptance:Government acceptance:
1. National Strategy for Fight against HIV/AIDS (2005)
2. Strategy for Youth Development and Health in the Republic of Serbia (2006)
3. Tobacco Control Strategy (2007)
4. Strategy for the Development of Mental Health Care (2007)
Legal basis for system development Legal basis for system development and health care reformand health care reform
System laws:System laws:
• Law on Drugs and Medical supplies (2004)
• Health Care Law (2005)
• Health Insurance Law (2005)
• Medical Chambers Law (2005)
By-laws and sub-laws (about 40 based on system laws):
• Law for communicable diseases• Law on sanitary inspection• Regulations based on the Law on
Medicines• Regulation on Co-payment fees
(personal contribution of the insured population in health care expenses)
• Network of health institutions• Continuous Quality Improvement • Licensing, accreditation and CME
Legal basis for PHC reformLegal basis for PHC reform
• Better defined health-care institutions according to levels of health care
• The chosen doctor concept
• Local community ownership of the primary health care centers
• Decentralization of management over PHC institutions
Partnerships in health system Partnerships in health system development and reformdevelopment and reform
International:International:
• WHO and UNICEF, UNDP• EU – EAR / the biggest
one (about 100 000 000 Euros)
• World Bank • ICRC • CIDA• Council of Europe• Bilateral partners – Japan,
Norway, France, Italy, China and others.
NGOs:NGOs:
About 50 professional organizations and NGOs dealing with programs or project in health sector
About 30 Roma NGOs as a partners of health institutions in implementation of Action plan for health of Roma population
Primary health carePrimary health care - our achievements! - our achievements!
• Pilot project “Basic health benefit package Kraljevo municipality”; - basic services package, capitation and development of information system
• Decentralisation and transfer of authority to the local community (municipality)
• Separation of the specialist-consultant service
• Reform of the dental health care• Development of preventive centers (EAR
Project Improving Preventive Health Services in Serbia)
• PHC system development (Balkans Primary Health Care Policy Project – CIDA
Public health achievementsPublic health achievements
• New models of financing Public Health Institutes
• Strengthening preventive health services (Centers for preventive care in PHC)
• Health promotion activities• Public Health strategy paper
developed, and• Public Health Law-draft
prepared• Establishment of the Serbian
Public Health Association
Vulnerable Vulnerable population population
groups groups in Serbiain Serbia
• Roma population – Census data108 193 (assessment is 400 000)
• Refugees – UNHCR data (97 953) • Internally displaced persons - UNHCR data (206 789)• Persons with disabilities ( assessment is 800 000)• Youth (21% of the total population)• Person older than 64 year (17% of the total
population)• Poor persons (10.6% of the total population below
poverty line)• Unemployed persons (26.6% of working population,
data for September 2007).
Ministry of Health BudgetMinistry of Health Budgetallocated to vulnerable groupsallocated to vulnerable groups
• Covering of the health insurance for uninsured person (about 50 millions of Euros)
• Realization of the project regarding the Roma Decade (about 250 000 Euros)
• Realization of other health project by NGO (about 60 000 Euros)
• Implementation of Strategy for drug and alcohol abused (about 250 000 Euros)
• Realization of project at the Institute for students health (about 40 000 Euros)
• Developing of the Program for mother and child care protection (about 60 000 Euros)
HIV/AIDSHIV/AIDSHealth Survey results:Health Survey results:
• 90.5% were aware of HIV/AIDS;• More than a third of the
population knew where they could get tested for HIV;
• 4.2% of adults have been tested for HIV;
• In Serbia in 2006 in comparison with 2000 the increased tolerance for HIV infected people was registered;
• 17.8% of young aged 15 to 19 had sufficient knowledge on HIV/AIDS, i.e. identified correctly ways to prevent sexual transmission which was an 11.1% improvement over 2000.
Activities of the MoH:Activities of the MoH:
Global Fund to Fight Against AIDS, Tuberculosis and Malaria Projects:
• Controlling HIV/AIDS in Serbia –Comprehensive Country Strategy and Emergency Action Plan (2003-2007)
• Scaling up the national HIV/AIDS response by decentralizing the delivery of key services (2007-2011)
• National Strategy for Fight against HIV/AIDS (2005)
TOBACCO CONTROL AND SMOKING PREVENTION – Our
achievements!
Our aimed Primary Health Care Our aimed Primary Health Care Vision Vision !!!!!!
• PHC doctor as “gate keeper” at the entry point to the health care system
• Comprehensiveness of services delivered to users
• Continuity of health care• Orientation towards community and
development of partnership with other actors in the public services provision to the population
• Coordination of services delivered on primary care and other levels of care