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Health Care Reform in Serbia


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

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

June 2nd 2008, Halifax, Canada
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

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

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
  • Overspecialization a polyclinic approach
  • Low efficiency and uneven quality of services
  • 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 2006(Institute of
Public Health of SerbiaDr Milan Jovanovic
  • A well-developed primary health-care institutions
    network - comprising 158 primary health care
  • 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 related to
  • 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
  • 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)

Legal basis for system development and health
care reform
  • By-laws and sub-laws (about 40 based on system
  • 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)

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

Partnerships in health system development and
  • International
  • EU EAR / the biggest one (about 100 000 000
  • 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

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

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

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
  • Persons with disabilities ( assessment is 800
  • Youth (21 of the total population)
  • Person older than 64 year (17 of the total
  • 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 Budgetallocated to vulnerable
  • 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)

  • 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
  • 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
  • Scaling up the national HIV/AIDS response by
    decentralizing the delivery of key services
  • National Strategy for Fight against HIV/AIDS

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

  • FOR