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Health Care Reform in Serbia

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Health Care Reform in Serbia Ivana Mi i , MD Assistant Minister June 2nd 2008, Halifax, Canada – PowerPoint PPT presentation

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Title: Health Care Reform in Serbia


1
Health Care Reform in Serbia
  • Ivana Mišic, MD
  • Assistant Minister

June 2nd 2008, Halifax, Canada
2
Demographic profile of Serbia (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

3
SERVICE DELIVERYOrganizational structure of the
public health system in Serbia
Tertiary health care level
Secondary health care level
Primary health care level
4
The 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)

5
Primary health care (PHC) situation in Serbia at
the beginning of the 21st century 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

6
PHC quality indicators in 2006(Institute of
Public Health of SerbiaDr Milan Jovanovic
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

7
Strategies of the Republic of Serbia related to
health
  • MoH participated in strategy papers development
  • Poverty reduction strategy paper (2003)
  • Plan of action for children (2004)
  • Action plan for health of Roma population (2005)
  • Strategy of aging (2005)
  • MoH initiated strategy papers development and
    Government acceptance
  • National Strategy for Fight against HIV/AIDS
    (2005)
  • Strategy for Youth Development and Health in the
    Republic of Serbia (2006)
  • Tobacco Control Strategy (2007)
  • Strategy for the Development of Mental Health
    Care (2007)

8
Legal basis for system development and health
care reform
  • 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
  • System laws
  • Law on Drugs and Medical supplies (2004)
  • Health Care Law (2005)
  • Health Insurance Law (2005)
  • Medical Chambers Law (2005)

9
Legal 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

10
Partnerships in health system development and
reform
  • 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
  • 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

11
Primary health care - 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

12
Public 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

13
Vulnerable population groups in Serbia
  • Roma population Census data
  • 108 193 (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).

14
Ministry of Health Budgetallocated 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)

15
HIV/AIDS
  • 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
  • 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)

16
TOBACCO CONTROL AND SMOKING PREVENTION Our
achievements!
17
Our aimed Primary Health Care 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

18
  • THANK YOU
  • FOR
  • YOUR ATTENTION!
  • www.zdarvlje.sr.gov.yu
  • ivana.misic_at_zdravlje.sr.gov.yu
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