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Evaluation of the Organization and Provision of Primary Care in Serbia 4 Acknowledgements

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Evaluation of the Organization and Provision of Primary Care in Serbia 4 Acknowledgements e valuation of the organization and provision of primary care in serbia and provision of primary of the organization valuation e valuation of the organization and p r o v i s i o n o f primary care in serbia A survey-based project in the regions of Vojvodina, Central Serbia and Belgrade Primary care in the WHO European Region Design, layout & production Phoenix Design Aid, Denmark e valuation of the organization and provision of primary care in serbia A survey-based project in the regions of Vojvodina, Central Serbia and Belgrade Institute of Public Health of Serbia “Dr Milan Jovanovic Batut” abstract In many countries in transition, health reforms are part of profound and comprehensive changes in essential societal functions and values. Reforms of (primary) care are not always based on evi- dence, and progress may be driven by political arguments or the interests of specific professional groups, rather than by the results of sound evaluations. However, policy-makers and managers nowadays increasingly demand evidence of the progress of reforms and the responsiveness of services. The implementation of the WHO Primary Care Evaluation Tool (PCET) aims to provide a structured approach to this by drawing on health system functions such as governance, financ- ing and resource generation, as well as the characteristics of a good PC service delivery system: accessibility, comprehensiveness, coordination and continuity. This report gives an overview on the findings for Serbia. The project was implemented in Serbia in 2009 in the framework of the 2008–2009 Biennial Col- laborative Agreement between the WHO Regional Office for Europe and the Ministry of Health of the Republic of Serbia, which lays out the main areas of work for collaboration between the par- ties. Other partners were the Netherland Institute for Health Services Research (NIVEL) – a WHO Collaborating Centre for Primary Care – and other stakeholders in the health system of Serbia, such as national policy experts, managers, medical educators, PC physicians and their patients. Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permis- sion to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). Keywords PRIMARY HEALTH CARE EVALUATION STUDIES HEALTH SYSTEMS PLANS – organization and administration HEALTH CARE REFORM HEALTH POLICY QUESTIONNAIRES SERBIA © World Health Organization 2010 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concern- ing the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the infor- mation contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. table of contents Abbreviations . 4 Acknowledgements . 5 Foreword . 6 Executive Summary . 7 1 Evaluating PC: backgrounds and application . 16 1.1. The theoretical framework of the Primary Care Evaluation Tool . 16 1.2. Overview of the PCET development and pilot testing . 23 1.3. Overview of the PCET implementation in Serbia . 24 2 Introduction to Serbia . 29 2.1. The country . 29 2.2 . Population and health . 30 2.3. The health care system . 33 3 Primary care in Serbia: national context . 37 3.1. Stewardship / governance . 37 3.2 . Resource generation . 45 3.3. Financing . 50 3.4. PC service delivery . 51 4 GPs and paediatrician responses . 52 4.1. Respondents’ characteristics . 52 4.2. Accessibility of care . 53 4.3. Continuity of care . 57 4.4. Coordination of care . 59 4.5. Comprehensiveness of care . 66 5 Patients responses . 83 5.1. Respondents’ characteristics . 83 5.2. Accessibility of care . 84 5.3. Continuity of care . 89 5.4. Coordination of care and choice of provider . 97 6 Conclusion . 99 6.1. Summary of findings . 99 6.2. Recommendations . ?? Annex Glossary of PC terms . 108 References . 110 abbreviations BCA Biennial Collaborative Agreement between the WHO Office for Europe and Member States CIS Commonwealth of Independent States CHC community health centre CME continuing medical education EU European Union EU15 European Union Member States before May 2004 GDP gross domestic product GP general practitioner HIF Health Insurance Fund IUD intrauterine device NGO non-governmental organization NIVEL Netherlands Institute for Health Services Research PC primary care PHC primary health care PCET Primary Care Evaluation Tool PPP purchasing power parity RH reproductive health SDR age-standardized death rate SMS Serbian Medical Society STI sexually transmitted infection TB tuberculosis WHO World Health Organization Evaluation of the organization and provision of primary care in Serbia 4 Acknowledgements The World Health Organization (WHO) Regional Office for Europe expresses appreciation to all those who contributed to the achievements of this project. The project implementation team: Principal writers: Wienke G.W. Boerma, the Netherlands Institute for Health Services Research (NIVEL) (technical project leader) Martina Pellny, WHO Regional Office for Europe (project coordinator) Dionne S. Kringos, NIVEL Reviewers and contributors: Slobodanka Gajic, Dr Milan Jovanovic Batut National Institute of Public Health Ivan Ivanovic, Batut National Institute of Public Health Mirjana Zivkovic Sulovic, Batut National Institute of Public Health Melita Vujnovic, WHO Country Office in Serbia Valentina Baltag, WHO Regional Office for Europe. The national working group: • The Ministry of Health Dr Ivana Misic; Dr Nebojsa Jokic • The Institute of Public Health of Serbia Dr Tanja Knezevic; Dr Slobodanka Gajic; Dr Ivan Ivanovic; Dr Mirjana Sulovic Zivkovic • The Regional Institute of Public Health of Vojvodina Dr Sonja Susnjevic; Dr Sanja Cankovic • The Regional Institute of Public Health of Belgrade Dr Vesna Dragicevic • The Medical University, Faculty of Medicine, Department of Social Medicine Prof Dr Snezana Simic • The Health Insurance Fund Ms Milica Miletic • The Serbian Medical Chamber Dr Tanja Radosavljevic • The Serbian Nursing Association Ms Milijana Matijevic • The Serbian Agency for Accreditation Ms Snezana Manic The project is grateful for the participation of all patients, PC physicians, field workers and local organizers in the regions of Vojvodina, Belgrade and Central Serbia. Evaluation of the organization and provision of primary care in Serbia 5 foreword Primary health care embodies the values and principles that WHO pursues in its world- wide effort to help countries strengthen their health systems efficiently and equitably. WHO renewed its commitment to global improvements in health, especially for the most disadvantaged populations, in the World health report 2008, which urges countries to act on evidence that access to PC services forms the core of an efficient and appropri- ate health care system. The title of the report underscores the urgency of its message: Primary health care – Now more than ever. Over the past 30 years, health in the 53 WHO Member States in the European Region has improved considerably overall, despite significant changes in the patterns and trends in disease occurrence, demographic profiles and exposure to major risks and hazards in a rapidly evolving socioeconomic environment. In addition, the Region has seen trends towards more integrated models of care and greater pluralism in the financing and organization of health systems. Governments are continuing to rethink their roles in population health and health care organization and delivery, thereby changing the context for framing and implementing health policy. This report evaluates PC developments in Serbia, using a methodology that characterizes a good PC system as one that is comprehensive, accessible, coordinated and integrated. Other necessary attributes are continuity and equal consideration to all the functions outlined in the WHO framework in order to improve the overall health system. This means that the financing arrangements, service delivery, human and other resources (such as appropriate facilities, equipment and drugs) and necessary legal frameworks and regulations must be in place, and the system must have effective leadership. The report thus
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