Health Action - in the Federal Republic of Yugoslavia

NEWSLETTER ON EMERGENCY PREPAREDNESS AND RE SPONSE, SEPTEMBER 2001

with the Council of Europe Development Bank, Ministers of health from south-east Europe with the support of the Ministry of Health of met in Dubrovnik, , from 31 August to Croatia. Ministers from seven countries in south 2 September to discuss and give political east Europe: , Bosnia and , support for improving the health of their Bulgaria, Croatia, Romania, FYR Macedonia, and populations, and particularly that of the Federal Republic of Yugoslavia participated vulnerable groups. Priority health issues, in the forum. policies and future actions for the region were explored. In the past decade most of these countries have experienced conflicts and economic collapse,

Health planning under Stability Pact which has impacted on the quality of health and The health needs of vulnera ble populations in health services. Improving the situation requires south east Europe meeting emerged from a a mobilization of human and financial resources, political initiative initiated by the EU in 1999 as a and the provision of know-how and modern conflict prevention mechanism aimed at technologies. In addition, there is a need to promoting stability and growth in the region. strengthen collaboration between countries and There are now around 60 partners involved. improve the coordination of international After lobbying from WHO, the Council of Europe cooperation and support for the reconstruction and other partners , health has been included on and development of health infrastructures in the the Stability Pact agenda as part of the region. In line with this, representatives of “Initiative for Social Cohesion” and a health neighbouring (Hungary, Moldova, Slovenia and action plan has been drawn up. Underlying the Turkey) and other European countries (France, decision was the recognition of health as an Germany, Greece, Italy, Sweden and the UK) important determinant of social cohesion and a and international organizations like the World major factor in peace building, investment and Bank, the Council of Europe Development Bank development. The Stability Pact process is an and UNICEF were invite d to participate. opportunity to boost public health and health Project proposals in seven key areas underwent development in the countries of south east initial review at the meeting and four were Europe. identified as urgent priority areas to be The health action plan has three strategic presented to the forthcoming donors conference regional health objectives: 1. cost-effective in Bucharest in October: 1. capacity building; 2. reorientation and restructuring of health services strengthening community ; 3. to deliver high-quality health for all, particularly strengthening the surveillance and control of vulnerable groups; 2. restructuring and communicable diseases; and 4. establishing strengthening of the public health function and social and health information networks. infrastructure; and 3. developing professional Ultimately, in a strong show of political capacities. commitment, the ministers of health of south The health ministers’ meeting was jointly east Europe signed the Dubrovnik Pledge, organized by the WHO Regional Office for committing themselves to meeting the goals Europe and the Council of Europe, in association outlined above.

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Management course runs in Belgrade analyses. Topics included organizational and human resource development, quality A health management course held on 10-15 management, staff supervision and support, September at the Medical Faculty of Belgrade budgeting and financial planning, team provided an opportunity for people working in building, health sector reform and change management positions to upgrade their management. knowledge of modern management techniques Dr Vian said participants had “a keen and practical skills applicable in the workplace. understanding of their problems and a willingness to explore new techniques and methods for addressing them”. Positive feedback was given about the content and participative methods used in the workshop, particularly group work, which gave participants a chance to share their experience and ideas.

Emergency paediatric services Pictured here from L- R: Dr Luigi Migliorini, Head of UNICEF is seeking to reduce mortality and Office WHO Belgrade, with course tutors Dr Taryn morbidity rates with a new project addressing Vian and Dr Andy Beggs. problems of childhood injury and accidental The course was organized and funded by poisoning. The agency reports that 14.2% of WHO. Participants were nominated by the children in Yugoslavia die each year from these Serbian Ministry of Health and represented causes and the risk increases with age, a cross-section of senior personnel from all accounting for 1% of at age one, 18% at levels of the system. Most of age six and 46% by ages 7-18. The project aims the 28 participants were medical doctors to increase community education and awareness and many were directors with upper-level of these problems and upgrade treatment management responsibilities. services for acutely sick or injured children. The course was designed and facilitated by Injury and poisoning are largely preventable Dr Andy Beggs and Dr Taryn Vian from the illnesses whose incidence can be reduced by Department of International Health, Boston education campaigns that make both parents University School of Public Health, USA, a and children more aware of risks. Children centre which has extensive work experience presenting with these problems need timely, in countries in transition. specialised intervention. UNICEF estimates that around 400 000 emergency examinations of Sessions involved lectures, group paediatric patients are carried out annually in discussions, presentations and case study Serbia. This means around a quarter of the 1.5 million children and adolescents in the population seek emergency medical assistance at least once a year, at a heavy cost in time and resources for the health care system. This burden could be significantly reduced through education and awareness about injury and poising. UNICEF has identified shortfalls in the Participants represented the Federal Secretariat of emergency care available to children. One Health, Serbian MoH, Health Insurance Fund, IPH problem is the gap between theory and clinical and and health centres from around Serbia. skills among some health professionals. Another

2 is the fact that paediatric patients access a risk factors at an early stage. They provide a system designed to deal with an adult caseload. crucial link between the community and As well as not being tailored to meet the specific institutional health care and social services. needs of children, these emergency services are There is a long tradition of visiting nurses in overloaded and have functional problems related Yugoslavia, but the overall quality and to poor management, outdated equipment and a availability of this care has deteriorated in the lack of patient transport. past ten years. Essential materials are often in The project will establish an “emergency short supply, equipment is outdated and poorly paediatric service” within the existing maintained, and transport is a problem in many emergency services and train health areas. All of these issues have had an adverse professionals treating children and adolescents. effect on staff motivation. Teachers and other professionals working with The training curriculum developed by UNICEF children and their parents will also be trained in covers topics such as safe motherhood, family the prevention of childhood injuries and basic planning, care of newborns, immunisation, emergency paediatric care. Training commenced breastfeeding, growth monitoring, ARI, this month and courses will run until the end of diarrhoea, hygiene, stress management, early the year. UNICEF will publish a manual on childhood development, HIV/AIDS, prevention of “prevention of injuries” for all parents in the childhood injuries and the early detection of country, provide equipment to emergency disabilities. Each patronage nurse is also services in the Mother and Child Health Care equipped with a nurse’s bag, medical Institute of Serbia and to community health care consumables and educational material. centres, and donate ambulances and first aid The project is being implementing through the kits. Mother and Child Health Institute of Serbia and Implementing partners are the Institute of the Institute of Public Health of Belgrade and will Mother & Child Health Care of Serbia, the continue until all nurses in the system have had Federal Institute of Public Health, the Yugoslav access to training. Other plans include Red Cross, “Friends of Children of Serbia”, scout strengthening home visiting to ensure that one organizations, the Ministry of Health, the to two visits are made to families monthly, Ministry of Education and Sports, as well as the establish parents support groups, and provide network of public health institutes and health basic equipment for patronage services such as centres in the country. chairs, movable tables and vehicles for services in remote areas. Visiting nurses project ongoing Five-hundred nurses have now participated in In brief UNICEF’s visiting nurses project, now in its third q UN agencies are preparing the 2002 year. The project was initially set up to revitalise Consolidated Interagency Appeal (CAP) to homecare nursing services, and in particular to fund humanitarian assistance activities. The ensure that families have access to maternal & amount requested will be less than in child health care. The project involves training to previous years, approximately US$ 100 upgrade the knowledge and skills of nurses, and million compared with US$ 180 million for donations of essential e quipment, all designed to 2001. improve capacities and staff moral and provide a q WFP will downsize food aid and reduce better standard of care. beneficiaries in 2002. Assistance to refugees The visiting (patronage) nurses service in Serbia will continue; currently around half of all has 1 400 employees. Each nurse is responsible registered refugees use food aid. ICRC will for covering the health needs of 5-10 000 also reduce its food associated commitments people. Their work is carried out in the in 2002. This will mainly affect the some community and in schools and kindergartens. 228 500 IDPs, who are the principal Visiting nurses check the health status of the beneficiaries (ICRC figures). population, provide health education to families, and are in a position to detect health or social

3 The two agencies will coordinate their The health sector is one of the areas to be respective downscaling and it is hoped that included in the SAC programme. some bilateral donors will fill gaps. Upcoming Events q This month, ICRC completed its two-year q 9-10 October: Pre-conference seminar, programme of providing surgical materials organized by MoH/HCRC (part of the health to medical institutions in the Federal Repubic care reform consultative process). The of Yugoslavia. The project, worth a total of purpose is to discuss key topics on the DM 5 million, funded regular donations of agenda of the forthcoming Health Care basic medical items to 35 hospitals in Serbia Reform Conference, in order to promote and five in . ICRC will keep active participation in this forum. assisting health institutions in the Kraljevo Participants in the seminar will be HCRC and municipality, which has the largest its working members, representatives of concentration of IDPs in the country. institutions delegated to the National Health q DACU met with line ministries and donors in Council, and other experts. September to further discuss the allocation q 16-17 October: Health Care Reform of Brussels funds to individual sectors. Conference. Topic areas for the conference q A World Bank mission was in country in are health care financing, primary health September to discuss structural adjustment care, care, training and education. credits (SAC) for the Government of Serbia.

SOUTH SERBIA

MSF-G pilots support for diabetics than other patients without the same level of support. MSF-G is implementing a pilot project in south Serbia directed at improving the health of insulin According to IPH Belgrade, 480 000 people in Serbia suffer from diabetes mellitus and 10% dependent patients. Phase one of the project are totally insulin dependent. MSF says these was launched in April with patients from Nis, and people face problems of limited and poor quality in October phase two will start in the Leskovac insulin supplies, high prices, an inadequate and Pcinja districts (Vranje, Surdulica and system for medical testing and patient follow up, Bujanovac). The project will run for 18 months, and limited education about their disease. concluding in September 2002. 144 beneficiaries Project activities address the aforementioned have been selected for assistance that will last issues. Firstly, patients receive medical items for 12 months: 44 people in Nis, 50 in Leskovac and 12 months through certain institutions. 50 in Pcinjski. All are vulnerable insulin Laboratory testing is carried out according to dependent patients with different complications, international standards (WHO), and two new IDPs, refugees, and social cases. tests (Hb Ac1, and MicroAlbuminUria) have been In the first three months, patients receive free introduced in the participating health facilities. insulin, syringes and needles, laboratory testing MSF-G is supplying all the reagents for and regular medical check ups. They then attend laboratory testing. training sessions to educate them about Patients are divided into small groups and have diabetes and management strategies. MSF-G regular follow-up from the same doctor, who expects their patients will have better controlled examines them and discusses different aspects diabetes and be more informed and proactive of diabetes at these visits. with regard to their own health as a result of the A range of specialists participate in the follow up project. They are testing whether this group will including ophthalmologists, nephrologists, and have fewer complications related to their disease cardiologists. Nurses organise testing, hospital

4 visits, distribution of supplies and patient q ECHO will support rehabilitation and training. provision of equipment to health houses (dz) Courses run over eight weeks to cover insulin to strengthen the primary health care therapy, diabetic diet, self-management system. strategies, physical activities, and acute and q UNHCR continues to assist returnees to the chronic complications. A booklet, “Managing former GSZ and refugees from Macedonia. Your Diabetes,” has been produced in Serbian Few returns have taken place in Medvedja for patients. Pre and post training questionnaires compared with Presevo and Bujanovac give MSF-G feedback on the effectiveness of the municipalities. UNHCR will focus on trying to course. get people back to this area. The agency estimates some 7,000 refugees from Macedonia remain in southern Serbia and most want to return following the recent ceasefire agreement and deployment of NATO troops. UNHCR, ICRC, and local authorities are now preparing lists of people for assisted returns. q Provision of quality maternity services in Presevo. There are no maternity facilities in the Presevo municipality and women either have home births or need to travel to access medical care. A new maternity ward has been built and there is strong community and political pressure to open this as soon as possible, but WHO and UNICEF are concerned about the state of the building. Dr Sartoris said structural problems such as leaking water pipes, a non-functional

Map provided by MSF-G. sewerage system, and insufficient space to manoeuvre patient trolleys mean urgent MSF-G is also focusing on patient advocacy, building repairs need to carried out, even if including national and international standards on this means a delay in opening the ward. She patients rights in the booklet and work with called on agencies to step in with quick patients and doctors during the project. Patients assistance. involved in the Nis trial recently completed their q Donations of equipment in the region needs training course. They will continue to receive to be better balanced, as some centers have supplies and follow up for the next 7 months. been overlooked by donors and others Sustainability of any positive impacts from the oversupplied. Donations must be made project will depend on beneficiaries maintaining transparent by donors and recipients to lifestyle changes and regular access to medical avoid overlap and waste of resources. supplies in the future. q UNICEF will support the IPH of Vranje to carryout immunization in the Presevo and WHO health coordination meeting Bujanovac municipalities. The monthly health coordination meeting in south Serbia was held on 7 September in Vranje, chaired by Dr Chiara Sartoris from WHO Nis. Key items were:

5 MONTENEGRO

In Brief then submitted to the Montenegran parliament in December. q The first summer school for AIDS educators was run in Cetinje at the end of August. q Dr Cristina Profili, Head of the WHO WHO and UNICEF sponsored the event, suboffice in Podgorica, has transferred to her organized by the local NGO Cazas new post of WHO Head of Mission in Skopje, (Montenegrin Association for AIDS), with the FYR Macedonia. WHO wishes to thank Dr assistance of educators from IPH and the Profili for her dedicated efforts and support NGO Jazas. Fifty young people from to the health sector in Montenegro. Dr Jukka municipalities across Montenegro learnt Pukkila, Deputy Head of WHO in FRY, will about the epidemiology of HIV/AIDs, the head the Podgorica suboffice. clinical profile of the disease and its psychological impact. They will now visit schools in their local municipality and pass this information on to other young people. q “Safe immunization” seminars recom- menced, on 12 September 2001, to educate health workers and doctors about the unwanted side effects of immunization, the management of cold chain equipment, safe vaccination procedures and the surveillance of preventable diseases. Four Dr Profili is pictured here at a farewell dinner with seminars are scheduled for September/ the Minister of , Dr Zarko October Micovic. q IPH of Podgorica (IPH-P) completed the third and final round of vaccinations for Roma Upcoming Events children living in collective centres this q The 11th Montenegran Doctors Congress will month. The campaign started in June, be held on 10–14 October in Herceg Novi. aiming to immunize vulnerable children The key themes for 2001 are: Mental health against polio and other vaccine preventable – challenges for the 21st century and diseases. Systemic Diseases . For further information q The first intersectoral “Montenegrin about the congress please contact: Dr Rajko Commission Against HIV/AIDS” met in mid- Zarubica, president of the organizing board, September. Its mandate is to develop an 088 21 193; Prof. Dr Marina Bujko, 081 224 action plan for HIV/AIDS in Montenegro. 267. Issues to be addressed at this and future q WHO is holding a seminar for mental health sessions include access to condoms, public specialists from across Europe in Sveti information campaigns, payment procedures Stefan, Montenegro, from 4 to 7 October. for treatment, counselling services and One of the main themes to be discussed is ensuring that patients can access all their forensic psychiatry. diagnostic and treatment needs within Montenegro. q MoH Montenegro is drafting new health care and health insurance laws to pave the way for future reforms. These will be available for consultation by the end of October and

6 Health Action in the Federal Republic of List of abbreviations: Yugoslavia is a newsletter of the Emergency AAR: Association for Aid and Relief Preparedness and Response programme at the ACF: Action Contre la Faim World Health Organization Regional Office for ADRA: Adventist Relief Development Assoc. Europe. The information is compiled by the WHO ARC: American Refugee Committee Humanitarian Assistance Programme in Belgrade, ARI: Acute respiratory Federal Republic of Yugoslavia. CHF: Cooperative housing foundation CI: Cooperazione Italiana All rights are reserved by the organization. The DACU: Development and Cooperation unit document may, however, be freely reviewed, DFID: Department for International development abstracted, reproduced or translated in part or whole, ECHO: European Community Humanitarian but not for sale or for use in conjunction with Office commercial purposes. This newsletter is not an EAR: European Agency for Reconstruction official WHO publication. The views expressed in it EUMM: European Union Monitoring Mission do not necessary represent stated policy of WHO. FMoH: Federal Ministry of Health Correspondence should be addressed to: FRC: French Red Cross Health Action in the Federal Republic of Yugoslavia FRY: Federal Republic of Yugoslavia WHO Belgrade Office GRC: German Red Cross Bulevar Mira 8 GTZ: German Technical Cooperation Belgrade 11000, Federal Republic of Yugoslavia HCRC: Health Care Reform Commission HI: Handicap International Attn : Nicole Mullane HRT: Hellenic Rescue Team Tel.: (+381) 011 664 557 ICMC: International Catholic Migration office Fax: (+381) 011 660 735 ICRC: International Committee of the Red Cross ICS: Italian Consortium of Solidarity Chief Editor: Dr Giuseppe Annunziata [[email protected]] ICVA: International Council of Voluntary Editorial team : Jeffrey V. Lazarus [[email protected]]; Dr Agencies Luigi Migliorini [[email protected]]; Nicole Mullane IDPs: Internally displaced persons [[email protected]] IFRC: International Federation of the Red Cross For more information about WHO emergency IMC: International Medical Corps preparedness and response programmes in the IOCC: International Orthodox Christian Charities European Region, please contact: IOM: International Organisation for Migration IPH: Institute of Public Health Dr. Jan Theunissen [[email protected]] IRC: International Rescue Committee Dr. Edouard Kossenko [[email protected]] IRD: International Relief and Development The newsletters of the Emergency Preparedness and JEN: Japanese Emergency NGOs Response programme (EHA) can be found at MDM-G: Medecins du Monde -Greece http://par.who.dk/: MDM-F: Medecins du Monde -France · Health Action in the Federal Republic of MIER: Ministry for International and Economic Yugoslavia Relations MoH: Ministry of Health · Health Action in the former Yugoslav Republic of MoSA: Ministry of Social Affairs Macedonia MoF: Ministry of Finance · Health Action in MoD: Ministry of Defence MSF-B: Medecins sans Frontieres-Belgium Health Action in the North Caucasus · MSF-G: Medecins sans Frontieres-Greece · Health Action in Tajikistan NF: Nuova Frontiera NGO: Non-governmental organization OCHA: United Nations Office for the Coordination of Humanitarian Affairs OSCE: The Organization for Security and Co- operation in Europe PHC: Primary health care PSF: Pharmaciens Sans Frontieres SCF: Save the Children Fund (UK) SDC: Swiss Agency for Development & Coop. SRC: Swedish Red Cross UNICEF: United Nations Childrens Fund UNHCR: United Nations High Commissioner for Refugees USAID: US Agency for International Development WFP: World Food Programme WHO: World Health Organization YRC: Yugoslav Red Cross

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