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

THANK YOU THANK YOU

FOR FOR

YOUR ATTENTION!YOUR ATTENTION!

www.zdarvlje.sr.gov.yu ivana.misic@zdravlje.sr.gov.yu