Number 9 May 2020 U Ovom Broju

PREPARED BY STUDENTS OF MASTER STUDY PROGRAM HEALTH INFORMATION MANAGEMENT

Number 9 May 2020 U ovom broju:

• Health workers (physicians, nurses, dentists, pharmacist) density in Montenegro,

• E-health in Montenegro, ANAMIRA LASICA RADOVIĆ • Role of the patient - centered health technologies in Montenegro,

• Problems caused by temporary measures introduced in Montenegro and the world overall, MILICA MILETIĆ • Covid-19 call center activity report for period 20 March – 18 April 2020, NATALIJA DREKALOVIĆ, BOGDAN LABAN

• ThePROF. structure DR DRAGAN of health LAUŠEVIĆ, system DR in Montenegro,ALEKSANDAR OBRADOVIĆ, DR MARIJA TODOROVIĆ, MR ENA GRBOVIĆ • Deaths attributable to air pollution in Montenegro, ŽELJKO MILIĆ • djelatnosti,LUKA MARAŠ Unapređenje aplikativnog rješenja eZdravlje uključivanjem stomatološke zdrastvene • NATAŠA DEVIĆ • MentalCiljevi i metode health statusskrininga in uMontenegro, zdravlju, NATAŠA ŽUGIĆ • Prevencija povreda i nasilja - kratak osvrt, NINA MILOVIĆ • Prevencija i rehabilitacija kardiovaskularnih bolesti, SVETLANA STOJANOVIĆ

TIJANA LUČIĆ

Mira Radović, Adviser in the Directorate for public health and programme health protection, Ministry of Health student of Master studies in health information management, UDG

ABSTRACT Population health care is implemented at all lev- - els, based on the set goals, strategies, programs ing healthy lives and promoting the well-being at and plans, in order to provide the WHO recom- allVision ages of is Sustainable essential to Development sustainable Goaldevelopment. is ensur mendation "Health for all under the same - tional network of health care providers at all levels accessIn accordance to physicians to the andSDG physicians by focusing status on providing are just ofconditions public health and equalneeds rights." to be planned The and organiza continu- somemore efficientof the ways funding to reduce of health ambient systems, pollution, increased ally improved. Through planning, it is necessary to provide an adequate number of staff, that is, differ- save the lives of millions. ent categories of health professionals / associates Humansignificant resources progress play can a becentral made role in helpingin the ad to- and the necessary non-medical staff. vancement of the health sector, but in Montene- The process of human resource planning in the grro, as in many countries, there is a shortage of healthcare industry ensures the continuous im- medical staff in certain branches of medicine and provement of the quality of health care through inadequate geographical distribution. the implementation of the principles of inclusive- Strategic activities must be undertaken in the fu- ness, equity, accessibility and solidarity. In the analysis of human resources, in addition to orga- care personnel in order to keep them and prefera- - blyture to period, increase primarily them, which financial is essential support in for order health to quired and demographic structure and population keep the quality of health care in Montenegro. projectionsnizational network with special health emphasis care providers on the analysis are re Key words: Montenegro, density, physicians, of the age structure of employees in the health sec- nurses, dentists, pharmacists, workload. evaluates epidemiological situation. As the health INTRODUCTION caretor. Preferably system ensures analyzes the and protection migration trendsof human and Health workers, as the main human resource in health throughout the life span, it must be contin- the health care system, with their knowledge, ex- uously reformed in accordance with the needs and perience and skills should enable the implemen- requirements of the population. tation of health policies in order to preserve and improve the health of the population.

care units. zational structure of the network of dental health healthmaking professionals this study highly in Montenegro significant have for a decisionpositive a large workload of available staff, and having in attitudemakers. when This confirmsit comes theto business hypothesis opportunities that most mindInsufficient the low numberpay power, of healthdissatisfaction workers with leads the to abroad. existing staff may result in the question of the The migration of skilled health professionals di- threat of migration of health workers to coun- rectly affects the health system of the country, and tries with the better standard. Migration of health thus the health of the population, as well as the workers is a global phenomenon, and it is of great health workers who remain in the country. It is ex- importance for countries to know the exact rea- pected that healthcare professionals who remain son that motivates health workers to seek work in public health systems with an inadequate num- abroad. Since the migration of large number of ber of health care providers will experience addi- health workers affects the availability and quality tional stress and a higher workload, lack adequate of health services, represents an irreversible loss supervision and information, and have limited ca- of money invested in the development of human reer opportunities. resources, while also hampering the necessary Conclusion transfer of knowledge to younger generations. The available statistics, obtained on the basis Even tho principal objectives in human resources of reporting forms on the census of health care planning are: adjustment of education of health workers in health care institutions, in particular resources to society needs - continuous advance- on the number of doctors and health care profes- ment of knowledge and skills, development of ca- sionals, and their number per 100,000 inhabitants pacities for human resources management, mobil- (percentiles) for a period of 10 years, determined ity of health workers, threat that health workers for outpatient and hospital health care, indicate a may start migrating can be a huge issue for the health system in Montenegro, specialy since the Montenegro in relation to some countries of the - EUsignificant or European lack or region shortage On the of humanbasis of resources data on the of ing services. total number of medical doctors and other health- DirectiveThe results 2005/36/EU of the study, enables which freewas flowconducted of nurs in care professionals, higher and secondary educa- October 2016 on a representative sample of health tion equations are used to determine the linear workers - doctors in Montenegro, showed that trend equations by the abbreviated method for almost 60% of doctors in Montenegro could be pairwise series of data. considered as potential migrants - given that they However, example of dentist in Montenegro, had considered leaving the country for business as well as other medical workers shows that the workload of health care staff in both outpatient and inpatient healthcare in Montenegro is uneven Staffopportunities report on abroad.permanent A framework employees of for the defining public and unsatisfactory. Compared to EU countries, this healththe sample system represented in Montenegro the official at the data end fromof 2015, the number is noticeably lower, and it is also a similar

References • Situational analysis of health care in Montenegro for 2015. In- stitute of Public Health • Report on the work of the Health Insurance Fund of Montene- gro for 2017 • Analysis of Human Resources in the Health Care System of Montenegro 2008-2017 • Master plan for health development in the period 2015-2020 • 39/2016, 2/2017, 44/2018 i 24/19) • LawMaster on plan Health for health Care (Official development Gazette in the of Montenegroperiod 2015-2020 03/16, • Master plan for health development in the period 2015-2020 • https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex- Source: https://ec.europa.eu/eurostat; %3A32005L0036 http://data.euro.who.int/hfadb (EU region-2014) • https://ec.europa.eu/eurostat • http://data.euro.who.int/hfadb •

• http://www.ijzcg.me/wp-ontent/uploads/2017/10/Analiza-Staff report on permanent employees of the public health sys- zdravstvene-za%C5%A1tite-u-Crnoj-Gori-20151.pdftem in Montenegro, as of the end of 2015, Institute of Public Health of Montenegro 2016

Ana Lasica, Intern, ERSTE Bank student of Master studies in health information management, UDG

The health care systems are expected to have a good quality and up-to-date response to citi- allows their users to make an online appointment,practitoners as well in as health to check, centers. cancel e-Zakazivanje or change health care delivery should be in conformity with their appointment. currentzens' expertise, needs for focused health on care. the This needs implies and goals that • eRecept (e-Prescriptions) - an electronic ser- of individuals, their families and the entire com- vice that provides patients with insight into munity, concerning patients as key partners in the - treatment process. Patients which are better in- tients can receive information about their formed will be able to manage their health more prescriptionsprescribed and at any realized time, both prescriptions. those who are Pa effectively in the context of daily life and maintain active and those that have been used in the optimal well-being. last 6 months with information about where In Montenegro, the health care system reform and when they were used. started in 2004. One of its goals was to improve • quality to ensure equal access, fairness and safety provides patients with insight into the results of evidence-based healthcare, while facilitating the eNalaz (e-Results) - an electronic service that- continued development of skills and technologies vice was developed with the goal of giving in- as well as patient involvement in decision-making. formationof biochemical on the laboratory provided analyzes.services availableThe ser - to patients as soon as possible. In this way, pa- ance Fund in Montenegro can use the new sched- tients can chronologically monitor and search ulingFrom system 2017 thefor beneficiariestheir chosen ofgeneral the Health practitoner Insur the results of biochemical analysis they have performed at the health center. - • eApoteka (e-Pharmacy) - an electronic ser- vides- the applicationinformation and on the electronic portal called services „eZdravlje. in the healthcareme“. The eZdravlje system portalof Montenegro. enables the Accessing use and pro the the aim of providing information on the avail- portal can be done through a web address (www. abilityvice for of citizensmedicines (patients), at pharmacies developed in the with territory of Montenegro. They receive accurate me). The registration is done by typing the health information in which pharmacies prescribed bookezdravlje.me) number and or PIN. mobile application (eZdravlje. therapy can be taken. This service is of great importance when it comes to possible chang- • - es in the availability of certain medicines, in Electronicpointment services scheduling available serviceto citizens to are:general particular in the case of shortages of certain eZakazivanje (e-Scheduling) - an online ap European Commission Erasmus+ Project: | PROJECT COORDINATOR: University of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net medicines. manage their time better, beacuse waiting in lines • eOsiguranje (e-Insurance) - an electronic can be frustrating, especially today, when time is everyone’s most important resource into the status of their health insurance. • service that provides citizens with an insight- is a mobile application for reporting symptoms vice which provides ordering services (elec- andThe health latest status,step forward a part inof thea wider field integratedof e-medicine in- troniceNaručivanje prescriptions (e-Ordering) for chronic - an electronic patients; ser re- formation management system related to the on- ports for calculating the remuneration during going Corona pandemic in Montenegro, launched temporary work disability (sick leave); certif- by The Institute of Public Health of Montenegro. icates issued by the selected doctor; sick leave The mobile app provides an easy and secure way in accordance to current measures and deci- to report the symptoms and current health status of people under medical care in just a few clicks. - orderingsions of theof individual National Coordination electronic services Body for is ceive in an SMS message. They communicate with technicallyfight against possible COVID-19 for Infection).those who Electronic have ful- theCitizens epidemiology access the service,application sending via the the link most they im re- - portant information regarding their health, which tions for each of the services listed. makes easier the process of medical surveillance. filled the above mentioned specific precondi The use of software solutions in healthcare can help patients as well as the entire medical profes- sion, as it makes it easier to monitor the quality,

modern technologies, the data obtained can be safety and efficiency of medical services. Using practice of other countries, and the development ofanalyzed, such systems then in compared healthcare and is an aligned important with chal the- lenge of the 21st century. The use of IT technology in healthcare is imposed as a real need because it

while maintaining a high level of quality of health service.enables the limited resources to be used efficiently

- References • Picture 1: eZakazivanjeSource: (e-Scheduling) Author – one of the elec • tronic services on „eZdravlje.me“ portal • www.ezdravlje.mewww.ncbi.nlm.nih.gov/pubmed/19901351 - Patient-centered www.ijzcg.meCare - Reynolds A. They proved to be very useful, not only because • - they keep patients actively involved and informed „Strategija za poboljšanje kvaliteta zdravstvene zaštite i bezb about their health, but also for allowing them to jednostiJune 2019 pacijenata za period 2019-2023. godine sa Akcionim planom za 2019-2020. godine“ – public state document from

Milica Miletić, Software Developer, Exploring student of Master studies in health information management, UDG Coming from a background of Information Tech- be accessed by anyone, at any point of time and any nologies, I have always found that many systems in location. Patient-centered care is important for in- Montenegro need to be updated and redesigned so creasing the overall quality of the care that health we can move progressively forward. I haven’t had organisations provide. It empowers patients and any knowledge about healthcare systems in my also makes the physician’s jobs easier. country since the last time I visited hospital was We must differentiate PCC and customer service oriented care. Epstein[2] cautions that PCC future improvements. That’s how I discovered this is more than just “giving patients what they want, masteryears ago. program. But I knew it was an interesting field for when they want it.” And as Millenson notes, “what My understanding of patient-centred care is that distinguishes patient-centered care in its fullest it is focused to ensure that the patient is guiding all - clinical decisions of his/her own health matters. vice is that it involves actions undertaken in col- laborationsense from with beneficence patients, ornot better just on customer their behalf. ser patient as a unique human being.[1] Making that It requires clinicians to appropriately share power possibleBalint first would described not go PCCeasy as if it “understanding wasn’t for IT sys the- even when that sharing feels uncomfortable.”[3] tems. Not long time ago, patients didn’t have - cient to truly providing PCC. GoodMontenegrin customer health-care service is system important, was butplanned insuffi to be patient-centred. Of course, nothing really goes as smooth as planned. That’s why we have project - - temmanagement. by developing Specifically, basic infrastructure strategies of ourto enable coun healthcaretry were to facilities, create a modernphysicians and and flexible patients IT sys to

improving security and technological standards, benefit from ICT, creating electronic health cards, that integrates existing health and social IT systems.[4]and creating a unified health information system access to medical information or social communi- Montenegro has developed eHealth portal that ties. Medical school libraries were the only source provides users with information about electronic the one could search for this type of knowledge. Technology is growing so fast and knowledge can services that are available for our citizens. There European Commission Erasmus+ Project: are| PROJECT 5 services COORDINATOR: that are available University for citizens of Donja and 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net one for health facilities. They are named as fol- Then keep data about heart, like blood pressure, lows: eScheduling, eRecepie, eResult, ePharmacy, heart rate, oxygen saturation etc. There is also one and eInsurance. All these services combined are a interesting category called mindful minutes. Mind- great example of a role that patient-centred sys- fulness is a state of active, open attention on the tem is having here in Montenegro. Montenegro present. So it keeps track of how much I am being has also started a huge project of connecting all of calm, sort of my meditation time. In the category of medical facilities into one information system that nutrition I can keep track of how much important can allow users (physicians, nurses etc.) to use nutrients do I consume daily. I can also measure my inhaler usage and respiratory rate if I connect it to an app or something that could share data with Business intelligence. my phone. And phone itself can provide insights into my sleep habits. It can help me determine the amount of time I am in the bed and asleep. Hav- ing all of these possibilities just through a phone app assures me that PCC is becoming a huge thing nowadays. Where do I see potential growth of PCC technologies in Montenegro? Right there. Allow- ing users to keep all their data on their phone and making possible to connect technology and share industry due to the availability of data in diverse BI has a very important role in the healthcare- I see the future of health care, moving from paper ferent departments (For e.g. Some data regarding basedmedical records data over to electronic bluetooth, health wifi, etc. records. That’s where theformats customer which details makes is its with access the admindifficult department across dif and some reports of test are with the concerned References •

- • BalintEpstein E. RM, The Fiscella possibilities K, Lesser of patient-centered CS, Stange KC. Why medicine. the nation J R videlab), this, the makes task has difficult been tomade assemble easy toand a interpretgreat ex- Collneeds Gen a policyPract. 1969;17:269-276.push on patient-centered health care. Health Aff. 2010;29:1489-1495. tent.[5]data, but due to robust environment BI tools pro • Millenson ML. New roles and rules for patient-centered care. Since my job is software development, interesting • http://origin.who.int/goe/policies/countries/mne/en/ • J Gen Intern Med. 2014;29:979-980. - apps for me are GoogleHealth or Apple Health type Business Intelligence in Healthcare Industry by Anmol Khan me to keep records of allergies, clinical vitals, con- na, Dhruv Bhasin of apps. The one that I am using specifically, allows and procedures. Also, it keeps track of my daily walksditions, and immunizations, activities. I can lab update results, my medications body mea- surements, track menstruation cycles, check on my hearing using audio commands on the phone.

Natalija Drekalović, Bogdan Laban Freelance Dev, Upwork, Appen, Lionbridge student of Master studies in health information management, UDG

Current trends in the world, triggered by the mat comparable to other countries, so to further improve global cooperation. problems across all regions. Numerous institutions According to research, the most prevalent meth- COVID-19 pandemic, cause increasingly difficult ods of polling are CAWI (computer - assisted web interviewing) and CATI (computer - assisted tele- consequencesfind themselves of riddled socio-economic with obstacles, developments due to the in phone interviewing) methods as foundations for afact short that period they are of nottime. capable Even the to define top statistical causes and of- data collection, followed by usage of a program- ming language/tool (usually R or Python) for statistical analysis and graphical presentation of re- othersfices such have as: not Eurostat, managed World to avoid,Bank, orWorld overcome Trade sulting data. theseOrganization, obstacles UN yet. World Tourism Organization and Which brings us to the question: What can we ex- This data is essential to political structures and pect after the COVID-19 pandemic? strive to come up with the best possible socio-eco- was directly proportional to the needs and capa- nomiccitizens, laws, amongst and for others.that, they Various need to governments have a peek In Montenegro, the digitalization of the system in this data. In the upcoming weeks, government swift changes regarding the current state of tech- - bilities of its citizens. However, COVID-19 brought sential policies necessary to guide a country and various stores and malls, started offering their itsofficials people. are expected to prepare and carry out es servicesnology usage online, across basically the over board. night, Banks, followed schools, by One way of collecting, preparing and presenting all kinds of deliveries and bill payments. This pres- this data, when it is rather hard or impossible to - perform classic methods of polling, relies on sol- es have no access to. id knowledge and use of Information Systems and entsIt is avery load important of new data, to mention which our that statistical there is aoffic cer- Technologies. Regarding the use of technology, it tain trade-off between data collecting and privacy. is absolutely essential that the privacy of the cit- These new measures force an entire country and its populace into something they have not had con- the government. tact with before. These systems are new and un- izensDuring is athe number pandemic, one priority key information and guaranteed for eco by- tested, thus making people rightfully wonder, just nomic sustainability of a country can be found how safe are they? As mentioned beforehand, it is - absolutely essential that the government has this within its citizens. Collected data must be in a for European Commission Erasmus+ Project: | PROJECT COORDINATOR: University of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net completely under control and guarantees privacy. information needed to guide, or manipulate human Regarding Montenegro, CATI method would sure- consciousness. Many do not even realize that they are - tracked 24/7, and those that do, do not find it as much volves conducting telephone interviews, whereby disturbing as they should. Based on data collected ly show great success. Basically, this method in through a simple device found anywhere; a phone, into the system. This method is simple, doable, and certain companies can know whether a person has interviewers would fill out questionnaires directly- a positive or a negative outlook on the government; ods. Also, the cost of CATI model is much lower, whether they need a certain product; their browsing asvery interviewers time flexible will compared not have to to PAPI visit or households, CAPI meth history, location, and so much more. Yes, all those thus not have to be reimbursed for transportation apps might be free and really useful, but when you’re costs. Also, fewer interviewers will be required, not paying for it, you’re the product. This is a period leading to further cost reductions. when people should wonder whether the dark age re- Picture 1 Overview of data collection methods across the world ally ended, and with it, the dictatorship and monopoly in 2020. over information; lives. Montenegro went through some tough transition periods, in which it gained increasingly free market and people. Some of those events that left a mark in economy/history are: a) Transition from socialism to a free market (1989) b) Hyperinflation in Yugoslavia - crisis (1994) c) Transition from DEM to EUR – significant reforms (2001-2002) Source 1 Map created based on data from International Labour d) Transition to an independent, separate state (2006) Organization. e) World economic crisis (2008) More at: https://ilostat.ilo.org/topics/covid-19/covid-19-im- f) Montenegro’s EU accession talks begin (2012) pact-on-labour-market-statistics/#elementor-toc__heading-an- chor-9 g) Joining NATO (2017) h) COVID-19 pandemic - crisis (2020) Global issues are something that also greatly affects This period of development of Montenegro was our country. Such is global surveillance, which exist- marked by unrest caused by the civil wars that took ed for years, but only became crystal clear now (even place after the fall of socialism. The whole process is though everyone seems to always talk about it). Sci- accompanied by globalization flows, which are still entific and technological advancements heavily rely present in the sphere of computerization of society on exabytes of data they take from people all over the today. world, knowingly and unknowingly. There is no perfect model of civilization/society and As smart technology advanced so did surveillance. so the economic and political systems we strive for are Gigantic databases of shopping malls, health institu- almost always impossible. Furthermore, it is notice- tions, banks and markets essentially contain all the able that the governemt, political leaders to be pre- cise, are expected to come up with an instant solution:

Source 4 https://github.com/dascar5/Socio-Econom- Source 3 https://github.com/dascar5/Socio-Econom- ic-Movements-Of-Montenegro-Under-Covid19/blob/master/ ic-Movements-Of-Montenegro-Under-Covid19/blob/master/ Skripta.ipynb Skripta.ipynb

Source 6 https://github.com/dascar5/Socio-Econom- Source 5 https://github.com/dascar5/Socio-Econom- ic-Movements-Of-Montenegro-Under-Covid19/blob/master/ ic-Movements-Of-Montenegro-Under-Covid19/blob/master/ Skripta.ipynb Skripta.ipynb

prof. dr Dragan Laušević, dr Aleksandar Obradović, dr Marija Todorović, mr Ena Grbović Social worker in Center for health promotion, Institute of public health of Montenegro student of Master studies in health information management, UDG

Introduction After about ten days, due to the changing epi- The Call Center was opened at the Institute of demiological situation in the country, the regime Public Health of Montenegro on 20 March 2020, of work for student volunteers in the Call Cen- ter was changed. From that moment on, the Call they have been infected with a novel coronavirus Center has hired two students per day, with nine orand who is intended have been for in all direct citizens contact who suspectwith people that student volunteers in total rotation (those living alone in Podgorica). From the very beginning, and now most of the time, the additional positions of adequatewho have testedinformation positive every for theday virus. from By 8am calling to 11pm,the toll-free including number weekends 1616, andall citizens public holidays.can receive the employees of the Institute of Public Health of Montenegro.the operators in the Call Center have been filled by who are employed at the Institute of Public Health ofCitizens Montenegro. make theirAfter firstthe epidemiologicalcontact with operators history social medicine specialists, all from the Institute ofTogether Public Health, with them, work two daily epidemiologists at the Call Center. and Thefive further referred to either the competent prima- work of the epidemiologists/physicians is orga- ryand health the triage care center form areor for completed, further talk citizens with the are on-duty epidemiologist from the Institute of Pub- recruited every day at the Call Center, while the lic Health. nized in two shifts, in that two epidemiologists are Operators and on-duty epidemiologists/physi- internal agreement. cians from the Institute of Public Health of Monte- remainingIncoming fivecalls physicians rotate according to an negro work together at the center. Since the launch of the COVID-19 Call Center on Operative training at the Call Center was at- 20 March, and up until 18 April (30 days), 10,977 tended by 48 students of the Faculty of Medicine calls were received. Operators responded to every single call. On average, there were 366 incoming calls a day, (fields: medicine, dentistry and pharmacy) and with variations in the number of calls received, inthree three students 5-hour shiftsof the (maximum University fourof Donja students Gorica. per ranging from 161 (Saturday 18 April) to a maxi- shift).The work In this of theway, operators students washad initiallythree to organized four days mum of 774 (Wednesday 25 March). The number off during their engagement at the Call Center. of calls varied from day to day, meaning that if

Željko Milić Head of IT Service, Water Supply and sewerage Company of Bar student of Master studies in health information management, UDG

ABSTRACT health insurance (around 620,000 policyholders). The Montenegrin health care system is facing dif- In order to assure quality in the health care work- ferent challenges, and in order to bridge the gap er - patient relationship, the normative framework between opportunities and expectations, it is nec- has been changed in recent years, and measures essary to further implement reforms, improve the administrative capacity in this area. As the funda- Key words: - have been defined to improve institutional and tion,organization health system and establish its sustainability. Health Care, in accordance with the Rome Charter, Introduction Montenegro, physicians, organiza thismental through rights theof patients Law on are Patients defined ‘Rights by the furtherLaw on Economic and social circumstances in Montene- which implies an equal right to quality and con- the state of health care. The processes of change tinuousdefines eachhealthcare, individual in accordance right on patients’ with generally rights, towardsgro in recent a new years social have order indirectly are associated reflected with on accepted professional standards and ethical principles, with the right to alleviate suffering and pain gradual change and the establishment of new rela- at every stage of illness and condition at all levels tionships.many difficulties This is especially and problems, evidence which of a require complex a of health care. and sensitive health care system where it cannot Health care system in Montenegro is directly reg- be allowed to interfere with its implementation and to ensure the health security of the popula- Health Care and the Law on Health Insurance and tion. The Montenegrin health care system is facing otherulated laws by systemicsuch as the laws, Law first on Medicines, of all, the the Law Law on different challenges, and in order to bridge the gap on Protection of the Population from Infectious between opportunities and expectations, it is nec- Diseases, the Law on Emergency Medical Assis- essary to further implement reforms, improve the tance, the Law on Provision the Law on the Protec- tion of Patients’ Rights, the Law on the Taking and Health system in Montenegro Transplantation of Human Organs for the Purpose organizationThe health insurance and establish system its insustainability. Montenegro bears of Healing, and indirectly by other regulations. a great deal of resemblance to the systems in the Health care is provided at primary, secondary and countries in transition, especially the countries in tertiary levels.Insured persons also obtain health the territory of the former Yugoslavia. The system care in other health institutions with which the is based on the principles of compulsory health Fund concludes a contract on health care services insurance and the entire population is covered by Healt.h insurance outside the Republic of Monte-

European Commission Erasmus+ Project: | PROJECT COORDINATOR: University of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net negro is provided by the Fund’s insured persons in for the needs of all or more public health institu- accordance with the prescribed procedure, in the - health institutions of the Republic of Serbia with ually for their needs. Medical and technical aids: which the Fund has concluded contracts and other prostheticstions is carried and outorthotics, by a centralized as well as certainfund individ other institutions with which the Fund has business co- types of aids, are provided through the sub-agency operation, at the proposal of the appropriate doc- of the provider of medical and technical aids from the Decision on the network of health institutions - “Rudo Montenegro” Podgorica. Eye aids are pro- andtor’s uponoffice the of the approval Clinical of Center the Medical of Montenegro. Treatment At - Commissionthe suggestion abroad, of the theappropriate insured personsDoctor’s areOffices re- technical, hearing, aids for speech and breathing ferred to other medical institutions abroad for the aidsvided are through provided 24 privatethrough optical 6 private shops, suppliers while tiflowith whom the Fund has concluded contracts for the the most complex measures and procedures re- delivery of aids after a public call. gardingprovision diagnostic of highly specializedtesting, outpatient healthcare and covering hospital If the insured person receives health care outside the treatment. place of residence, he is entitled to reimbursement of The insured persons receive medical rehabilita- travel expenses in the amount of the lowest price by - means of public transport. When referring for med- - ical treatment abroad, travel expenses are approved altion Hospital at the “Meljine”Institute for rehabilitationSpecialized Medical after cardiac Reha according to the type of vehicle, depending on the surgery.bilitation Also,“Dr. Simo the Law Milošević” on Taking Igalo and and Transplant the Gener- health status of the insured person, as suggested by the doctor’s offices, ie the Fund’s First-degree Medical Treatment stipulates that funds for the procedures Commissions. foring taking Parts ofand the transplanting Human Body parts for theof the Purpose body for of Employees who have been temporarily prevented the purpose of treatment, ie for health care related from work are entitled to compensation for earnings to these procedures, as well as for monitoring the during temporary work disability, based on the report health status of the donor and recipient of the or- for calculation of earnings during temporary work gan, provided such rights from mandatory health disability. The compensation to be paid by the Fund insurance. to the employer is 70% of the grounds for compensa- Medicines and medical supplies are provided to tion, except in cases prescribed by law, for which the insured persons through pharmacies of the PHI compensation is 100% of the grounds for compensa- “Pharmacies of Montenegro Montefarm” and from tion, namely: temporary disability for work caused by other suppliers. Procurement of medicines and a injury at work and occupational illness, isolation due to germs, for donation of blood, tissues and organs, and public health services is carried out by the during pregnancy, for persons with malignancies, per- Montenegrinpart of medical Pharmacy devices forPharmaceutical the needs of Associa citizens- sons with disabilities and persons with mental illness. tion “Montefarm”, which was established with the Health care in Montenegro is mostly provided by - public health institutions founded by the states. Pri- icines, while the procurement of medical devices vate healthcare institutions, except in dentistry, are aim of supplying Montenegrin citizens with med European Commission Erasmus+ Project: | PROJECT COORDINATOR: University of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net more prominent in the pharmacy business. The field EU framework. of private health care is not adequately regulated, so The lack of awareness of citizens about their rights there are various forms of such activity, which are out as patients, as well as non-realization and weak pro- of control (on quality, price, protection of the insured, tection of patients’ rights are the main cause of the etc.) and which represent more opportunities for dissatisfaction of patients. Namely, if patients do earning employed doctors in public institutions (es- not know their rights, they do not know when they pecially specialists) than supplementing public health. have been damaged, and because of the complexity Insured persons also obtain health care in other health and specificity that characterizes the way health ser- institutions with which the Fund concludes a contract vices are provided. In the period of globalization and on health care provision. changes, health systems are exposed to permanently In addition to the right from compulsory health in- growing pressures, changing day after day. This cov- surance, health care is financed at the expense of the ers a wide range of impacts, such as demographic compulsory health insurance funds, which accord- changes, massive chronic non-communicable diseas- ing to Art 13 of the Law on Health Care should be es, and accelerated advancement of health technology provided by the state, beyond the compulsory health through possibilities of providing new interventions, insurance funds. So, health care for insured persons political expectations and public expectations. There- is provided in health institutions established by the fore, a special attention should be paid to health and Decision on the Network of Health Institutions. It to the conditions for preservation and improvement consists of a network of health care institutions: 18 of health, which will be accomplished not only by health centers, 7 general hospitals, 3 special hospitals, activities of the health sector, but by engagement of Clinical Center of Montenegro, Department of Emer- all social sectors. Principles of solidarity, universality, gency Medical Services, Blood Transfusion Institute equality, accessibility and quality, which are the basis of Montenegro, Meljine Private Hospital, Institute of for building a sustainable and integrated healthcare Physical Medicine and Rehabilitation Igalo, Institute system, with a citizen being the centre of the system, of Public Health, PHI Montefarm pharmacies, Rudo are bearers of socially-oriented European health care Montenegro for medical and technical aids and den- system also pursued by Montenegro within the pro- tal clinics. cess of EU integration of health. Health care reform in recent years has created the Conclusion preconditions for a sustainable and integrated health High-quality healthcare is defined as healthcare that care system based on the principles of solidarity, equi- uses available and appropriate resources in an effective ty, accessibility and quality with the citizen at the cen- way to contribute equally to improving the health of ter of the health care system. Specially since Montene- the population and patients. This implies that health gro is in the process of EU accession, and Montenegro care delivery is in line with current expertise, focused is also a member country of the WHO, international on the needs and goals of individuals, their families authority guiding and coordinating health policies and the entire community, preventing and avoiding of member countries of the United Nations (UN), it the harm associated with treatment, and involving is necessary to plan the health system development citizens and patients as key partners in the healing within the context of social, legislative and economic process. The changes are necessary and there is sev-

References System of Austria, Thomas SCHABETSBERGERa, , Elske • AMMENWERTH , Ruth BREU, Alexander HOERBST , Georg Montenegro”, no. 049/07, 041/10, 040/11) • GOEBEL, Robert PENZ, Klaus SCHINDELWIG, Herlinde- • Law on the Central Population Register (“Official Gazette of- TOTH, Raimund VOGL, Florian WOZAKa. negro, No. 079/08, 070/09, 044/12) • Rodin, S., Ćapeta T. and Goldner Lang I. (eds.), Choosing Eu- • Law on Personal Data Protection (Official Gazette of Monte ropean Court Judgments, New Informant, Zagreb 2009 • • http://www.pravo.unizg.hr/_download/repository/Ucin Law06/16) on Health Care (Official Gazette of Montenegro 03/16) ci_direktiva.pdfen.htm • Law on Health Insurance (Official Gazette of Montenegro- http://ec.europa.eu/health/programme/policy/index_ negro 80/08) Law on databases in health care (Official Gazette of Monte

Photo 1. The network of public health institutions in Montenegro

Luka Maraš Software Developer, International Bridge student of Master studies in health information management, UDG

Introduction used to be based on heavy industry, mostly man- Although health can be an abstract concept, ev- ufacturing raw materials. Examples of that are the ery one of us, without a doubt, would tell you that they would like to live healthy ever after. Even if we - could do everything we can to embrace a healthy ousAluminium air pollutants, plant in especiallyPodgorica, whenIronworks you considerin Nikšić lifestyle, there are also factors that are outside our thatand Papersocialists, factory that in built Berane. them, All had of lackthem of are care seri for decision-making grasp. Many external factors in- long term effects of air pollution, and were more - concerned for economic growth rather than sus- ditions, living and working conditions, socio-eco- tainable growth. After Yugoslavia broke apart nomic,fluence culturalour health, and like environmental social and community conditions. con In Montenegro’s industry slowly dwindled. For bet- this essay we will look deeper into environmental ter or for worse, most of the big air polluters, fac- factors in Montenegro, more precisely air pollu- tories, closed, so today we have less air pollution tion and its effects on health of the population of from industry than 30 years ago. Montenegro. Air pollution today Montenegro We can group air polluters in Montenegro into Montenegro is a small developing country of just three main groups: industry, transportation and 650 hundred people. It is situated in rather rocky space heating. terrain so most of the population is concentrated Podgorica, as the administrative center with a in urban areas. It’s capital, Podgorica, counts over central position in Montenegro, is the main one a 200 thousand people, the third of the county’s population. These urban centers, often industrial About 30% of all vehicles registered in Montene- centers too, are usually settled in valleys or basins, grotraffic are junction registered where in Podgorica. numerous It isroutes estimated intersect. that surrounded by mountains. We will see later why around 2,000 work days outside the tourist sea- this is important when discussing air pollution. son in Podgorica passengers from the direction of Montenegro’s health system as well as industry - is a legacy from socialist era. Health system is one sengers is about 15,000 daily. The capital city has hundred percent government-funded. It is very aboutBijelo 258Polje, km while of roads. from TheNikšić age the and number quality of of pas the much a very tightly coupled system reluctant to vehicles used should also be kept in mind (accord- change. ing to MONSTAT data in 2013. more than 54.2% of While a part of Yugoslavia, industry, and there- vehicles used in Montenegro were manufactured foreEuropean big sources Commission of pollution Erasmus+ flourished. Project: Industry before| PROJECT 1999), COORDINATOR:as well as traffic Universitytransit during of Donja the 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net summer months. Of the total number of vehicles, 230 t of carbon (IV) oxide, 3.57 t sulfur (IV) oxide, 58.3% use diesel fuel. The average age of a city bus 120 t water vapor and 0.36 t of suspended parti- is 19 years. cles. Despite protecting the basin high the chimney - of the thermal power plant, under adverse meteo- gorica does not have a steam power plant for rological conditions, helped by the terrain as Plje- centralUnlike heating.most capitals Podgorica in the also Balkan lacks Region, natural Pod gas vlja sits in a valley surrounded by mountains, and infrastructure so the only fuels available for heat- during the heating season of households (which ing are those that pollute more like wood or coal. burn wood), increase in the concentration of suspended particles has been reported. Due to the homes warm: either use electricity, or burn bio- - massThis leaves fuels. citizensFirewood with is the two most options represented to keep their fuel tator and the change in the applicable protection in the consumption of biomass in Montenegro. In regulationsinsufficient efficiencyenvironmental of the and electrostatic European precipi Union the publication “Consumption of Wood Fuels in requirements for the emission of pollutants from 2011 in Montenegro” (MONSTAT, 2013) it is stat- - was completed in 2009. wood and other wood fuels for heating. Of which energy the replacement of the electro-filter plant 21,733ed that (73.3%)29,623 households households in are Podgorica located inuse an fire ur- Impact on human health ban area. Only 60 households out of total number, The impact of increased concentrations of PM uses wood briquettes and pellets for heating. Ac- particles on human health is twofold - mechanical cording to the 2011 census report, the Podgorica and toxicological. The mechanical impact depends has 56,847 households, of which 47,362 are in the - city itself. These numbers say that at least 50% of ticles are more dangerous to human health in this - respectdirectly onas thethey particle can penetrate size. Smaller deeper, diameter although par ing. In the air quality report for 2014 European En- most of them are exhaled. The toxicological effect vironmentalthe population Agency uses (Airuntreated quality firewood in Europe for - 2014heat depends on the chemical composition of the PM Report, The EEA) states that fossil fuel combustion particles, which can be very different depending in households is the dominant source primary PM on the source of the pollution. They are composed particles. of a complex mixture of solid and liquid particles of organic and inorganic origin. Short-term and long- source of air pollution, period, in Montenegro is term impacts should also be distinguished. While theBiggest Coal Thermal industrial Power polluter, Plant and in Pljevlja. biggest In single Plje- short-term effects in healthy people can cause in- vlja TPP, lignite from local surface mines, which convenience that does not require clinical treat- in their own sense contribute to pollution by PM ment (respiratory irritation at high concentrations particles, is used as fuel. TPP “Pljevlja” has been in easy to spot, long-term effects can be much more TPP Pljevlja burnes 225 tonnes of coal per hour, serious,of dust, coughing,but they are sneezing, much more dry throat, serious. etc.) They and are is consumesoperation since200 tons1982. of Based oxygen on perthe hour,available emitting data,

European Commission Erasmus+ Project: also| PROJECT more difficult COORDINATOR: to isolate from University other influences of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net and create a causal link between disease and pol- WHO’s data on air pollution health effect in Mon- lution. Chronic exposure to PM particles adds to tenegro is extrapolated using statistical meth- the risk of developing cardiovascular and respira- ods, and therefore does not exactly represent tory diseases, as well as lung cancer. real-world situation, these numbers do look wor- Health institutions and health professionals in rying, to say at least. The fact is that air pollution - parameters do go over recommended limits, espe- lution on human health for years, and have un- - derlinedPljevlja have the increasebeen stressing in the numberthe influence of respirato of pol- ing. Western europe countries are phasing out coal powercially in plants, winter but due Montenegro’s to usage of firewood bulk of electricity for heat still comes from our singular power plant. Poli- withry diseases respiratory (figure disease 2, 3. and have 4.) shown that are the especially increase cies for urban planning and transportation could ofpronounced growth obstructive in children. syndrome Both children and asthma. and adults Ac- also help reduce air pollution in urban areas by cording to the data of the Children’s ward of the means of transportation that do not produce as - muchbanning pollution or reducing like, publictraffic, transportationand using alternative or bik- jaGeneral respiratory Hospital infections Pljevlja are and one the of Children’s the dominant and ing and walking. This topic is a complex both polit- problemsSchool dispensaries with children. of PZU Health Center Pljevl ical, economic and health problem, and should be In Montenegro, studies on the effects of air pol- that called as such. Recently government has de- lution on human health have not yet been con- cided not to invest in expanding the power plant in ducted. In order to make them possible it is nec- Pljevlja, Podgorica bult bicycle infrastructure and essary to improve health statistics and expand the country is investing in renewable sources of ener- air quality monitoring network. Available data on the impact of pollution on human health were obtained using statistical methods conducted mainly gy. Hopefully Montenegro finally lives up to its title - ofReferences being the first ecological country in the world. age values from the environment to conditions in • - scription of method, WHO, May 2018. Montenegro.by the World Health Organization applying aver • BurdenExposure of to disease ambient from air ambientpollution air from pollution particulate for 2016 matter - De for 2016, WHO, v5, May 2018. • National strategy for air quality management, Ministry of people die annually, on average, because of health Sustainable Development and Industry of Montenegro, Octo- problemsBased on relatedWHO data to fromair pollution 2016. Over in Montenegro.five hundred ber 2012. • Air Quality Plan for the Capital City of Podgorica, Ministry of Sustainable Development and Industry of Montenegro, Au- infections, eighty because of cancer, over two hun- gust 2015. Out of that fifteen die because of lower respiratory • Air Quality Plan for the Municipality of Pljevlja, Ministry of dred because of heart disease. Stroke related to air Sustainable Development and Industry of Montenegro, Feb- pollution takes 175 lives annually, while chronic ruary 2013. • Ambient Air Quality Database, WHO, April 2018. • Joint effects of air pollution - Data by country, WHO, 2016. End word • obstructive pulmonary disease takes fifty lives. & R.Vaccaro,. (2013). Air quality study for Montenegro Pljevl- Trozzi,ja area. Carlo10.2495/AIR130201. & S.Villa, & J.Knezević, & C.Leonardi, & A.Pejović, to understand it by looking at the data. Although To be able to fight back diseases, first you need European Commission Erasmus+ Project: | PROJECT COORDINATOR: University of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net European Commission Erasmus+ Project: | PROJECT COORDINATOR: University of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net Unapređenje aplikativnog rješenja eZdravlje uključivanjem stomatološke zdrastvene djelatnosti

Nataša Dević profesor matematike, OŠ “Božidar Vuković” student of Master studies in health information management, UDG

servisi. Crnogorski zdravstveni sistem je, po većini- ja (e-zdravstvo) razvijeni su pojedini elektronski- parametara koji ga karakterišu, relativno mali- tivno rjesenje, koje je po svojoj namjeni okrenu- sistem i kao takav pogodan je za uvođenje i prim U Crnoj Gori se koristi e-Zdravlje (Slika 1) aplika jenu novih znanja i iskustava i shodno tome relativno brzu transformaciju u jedan moderan, to prema pacijentima. Korisnici ovog rješenja su- usluga.kvalitetan i efikasan sistem sposoban da u pot osiguranici Fonda za zdravstveno osiguranje, koji- punosti zadovolji potrebe krajnjih korisnika svojih su registrovani kod izabranih doktora u Domovi - telephonema zdravlja. (IOS Ovo I Androidrjesenje OS).uključuje portal eZdravl Zdravstveno osiguranje u Crnoj Gori se bazira na je (www.ezdravlje.me) i aplikacije za mobilene obaveznom (socijalnom) osiguranju, koje se finan- sira iz doprinosa na zarade na teret zaposlenih -i poslodavaca i iz poreza. Osnovni principi su soli darnost i jednakost pristupu zdravstvenim uslu- gama. Obezbeđuje paket osnovnih zdravstvenih usluga za svo stanovništvo. Fond za zdravstve no osiguranje Crne Gore (u daljem tekstu: Fond),- shodno Zakonu o zdravstvenom osiguranju, vrši javna ovlašcenja u rješavanju o pravima i obave- zama iz obaveznog zdravstvenog osiguranja. Fond pravadonosi osiguranih godišnje lica. programe rada, predlaže finan sijskeIntegralni planove informacioni i donosi opšte sistem akte (u zadaljem ostvarivanje tekstu: Slika 1

- IS) zdravstva u Crnoj Gori obuhvata IS Fonda, Pristup portalu eZdravlje je moguć putem web IS primarne zdravstvene zaštite, IS apotekarske (pacijenta)adrese (www.ezdravlje.me) se obavlja elektronskim ili odgovarajuće nalogom mokoji djelatnosti, IS stomatološke zdravstvene zaštite na bilne aplikacije (eZdravlje.me). Prijava korisnika primarnom nivou, IS opštih bolnica, IS Zavoda za- hitnu medicinsku pomoc, IS Zavoda za transfuziju,- se sastoji od korisničkog imena (broj zdravstvene- IS Instituta za javno zdravlje i IS Agencije za ljek knjižice - desetocifreni broj koji je upisan na prvoj ove. Kao podrška elektronskoj razmjeni informaci strani zdravstvene knjižice) i lozinke. Da biste pris European Commission Erasmus+ Project: | PROJECT COORDINATOR: University of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net tupili elektronskim servisima, neophodno je da se Portal eZdravlje i •jedinstvena eZakazivanje je za sve elektronske servise. obratite svom izabranom doktoru ili nadležnoj- sastoji se od sledećih servisa: - kupodručnoj korisnik jedinici/filijali ce dobiti putem Fonda, sms-a kako ili e-mail-a. biste dobili : omogućava online zakazivanje odgovarajućiSvaki osiguranik korisnicki dobija nalog. osnovne Odgovarajuću informacije lozi o posjete, kao i provjeru, otkazivanje ili prom jenu zakazanih termina (izabrani doktor za- odrasle, izabrani doktor za žene i izabrani- načinu pristupa Portalu u momentu otvaranja- doktor za djecu). Na ovaj način se mogu zaka- korisničkog naloga. Za maloljetnog osiguranika,- zati sve vrste posjeta, osim preventivnih pre odnosno osiguranika lišenog poslovne sposobno • eReceptgleda (savjetovališta za djecu i redovnih imu- sti lozinku može preuzeti njegov roditelj ili zakon nizacija) i kućnih posjeta izabranih doktora. ski zastupnik. - : omogućava pacijentu uvid u prop- Osobe ženskog pola imaju dva izabrana doktora- macijeisane i orealizovane receptima recepte.koji su propisani Pacijent ina aktivni, svom (izabranog doktora za odrasle i izabranog dok nalogu u svakom trenutku može dobiti infor- tora za žene) i koriste isti korsinički nalog. Loz njih 6 mjeseci sa informacijom gdje i kada su inku dodjeljuje jedan od ovih izabranih doktora ili kao i o receptima koji su realizovani u posled Slika2.službenik Fonda u područnoj jedinici/filijali Fonda Pregled labaratoriskih nalaza

Slika 3. Pregled labaratoriskih nalaza po parametru

Nataša Žugić Načelnica u Direktoratu za projekte i ekonomiku u zdravstvu, Ministarstvo Zdravlja student of Master studies in health information management, UDG Rano otkrivanje maligniteta (skrining ili probir) je

- žena. preventivna multidisciplinarna javno-zdravstvena U našoj zemlji skrining raka dojke je počeo 2015.- aktivnost koju inicira država među zdravom popu ta,godine. sa intervalom Ciljna populacija pregleda obuhvatasvake druge sve godine. zdrave lacijom, sa prosječnim rizikom obolijevanja, u cilju žene u Crnoj Gori starosti od 40-69 godina živo detekcije maligniteta u ranim fazama bolesti što 01.01.2007. godine u ovoj grupi ima oko 114.000 rezultuje smanjenjem obolijevanja i smrtnosti od- Prema podacima MONSTAT-a u Crnoj Gori, na dan malignih bolesti za koje se skrining uvodi. Osnovni cilj organizovanja skrininga za neko maligno obol žena. U ovom trenutku, mamogram je najbolji- jenje je smanjenje smrtnosti izazvane tom bolešću- metod da se pronađe karcinom dojke kod vecine na teritoriji koja je obuhvaćena programom. žena. Mamogram je rendgenski snimak dojke. Ma karcinomU Crnoj Gori debelog se rade crijeva tri nacionalna (skrining rakaskrining kolorek pro- mogrami su najbolji način da se rak dojke pronađe- grama: karcinom dojke, karcinom grlića materice i rano, kada ga je lakše liječiti i prije nego što je dojke.dovoljno velik da izazove simptome. Redovni ma tuma), među kojime je rak dojke najčešći maligni mogrami mogu umanjiti rizik umiranja od raka tumor i jedan od vodećih uzroka smrtnosti kod

Indikatori procjene kvaliteta programa skrininga raka dojke

Indikatori procjene kvaliteta programa skrininga raka grlića materice

jno finansijskih sredstava, stratifikaciju rizika i European Commission Erasmus+ Project: | PROJECT COORDINATOR: University of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net Indikator procjene kvaliteta programa skrininga za CRC 2018-2019. god

References • https://www.nhs.uk/conditions/cervical-screening/ • (Datum pristupa: 31.01.2020) • https://onlinelibrary.wiley.com/doi/abs/10.1002/%28SI • Jaffer, S. (2017), Breast Cancer Screening and Prevention: CI%2910969896%28199909%29189%3A1%3C12%3A% HealthPodgorica, Screening septembar and Prevention,2011. godine Adult Guide • Nacionalni program za rano otkrivanje raka debelog crijeva (Datum pristupa: 31.01.2020) jun 2010. godine • 3AAID-PATH431%3E3.0.CO%3B2-F • Nacionlani program za rano otkrivanje raka dojke, Podgorica, (Datum pristupa: 04.02.2020) Podgorica, septembar 2011. godine https://www.ijzcg.me/me/odjeljenje-za-skrininge • Nacionalni program za rano otkrivanje raka grlića materice htm (Datum pristupa: 30.01.2020) https://www.cdc.gov/cancer/breast/basic_info/screening.

Nina Milović Ministry of Health Montenegro

Mental and physical health are two inseparable and brake for the development and implementa- companions, and their mutual impact and connec- tion of the state program regarding mental health tion is deep and complex. The concept of develop- care of the population. Mental illnesses are tra- ment of mental health should respect the sensibil- ditionally linked with the failure of acceptance ity of a society, and therefore its social, cultural, economic aspects. It is also important to stress out persons with mental health issues represents a that the need for cross-sectoral approach to the seriousby the society, problem, fear the and consequences stigma. Stigmatization of which are of problem of mental health should not be ignored. numerous and they are manifested both in experi- Montenegrin society is a traditional society with encing one’s own illness and in the reduced moti- rigid value system, in which the disease and men- vation to request professional assistance. Stigma, tal illness are considered as stigma of the family, due to mental illnesses is so strong that it creates a wall of silence in relation to this problem, wors- ens the underlying illness and makes it even more and therefore, it is very difficult to create a climate mentalthat will patients be acceptable and their for afamilies civilized is anda prejudice rational People with mental health problems have in- treatment of mental illness. The stigmatization of unbearable and difficult.

Burden of mental health disorders in Montenegro

Human resources in mental health

Svetlana Stojanović Ministartsvo zdravlja Crne Gore ternacionalnom i globalnom nivou. - Sradnja na globalnom i nacionalnom nivou i vaZnačajna i povreda oblast kako na djelovanja nacionalnom u oblastitako i na javnogregio- nalnomzdravlju i uglobalnom cilju smanjenja nivou brojaje prevencija smrtnih povredaslučaje uspjeha prevencije povreda i nasilja[2] je u mul- tidisciplinarnom,saradnja sa vladama multisektorskom je veoma značajna, i multitemats jer ključ- - i nasilja. Svjetska zdravstvena organizacija (SZO) [1] je na globalnom nivou partner zemljama člani kom pristupu, primjeni naučnih metoda i naučnih- cama i sistemu Ujedinjenih nacija, međunarodnim- rezultata iz više oblasti, primjeni najnovijih organizacijama, civilnom društvu, fondacijama, medicinskih i tehnoloških dostignuća, koji pred univerzitetima i istraživačkim institucijama u cil stavljaju nezaobilazni element svih aktivnosti u ju implementacije mjera i aktivnosti definisanih cilju efikasnijeg mapiranja problema, definisanja strateških dokumenta zasnovanim na naučnim- najefikasnijeg rješenja, monitoringa i evaluacije- njučinjenicama. na svim nivoima, saradnju sa pojedincima, jimpreduzetih partnerima, mjera. pored redovnoh sastanaka i kon- Ova veoma kompleksna oblast, zahtijeva sarad ferencija,U skladu sprovodi sa prethodno globalne navedenim, kampanje SZO prevencije sa svo regije, saradnju na nacionalnom, regionalnom, in- saradnju u okviru porodice, zajednice, opštine, povreda i nasilja, koje imaju za cilj podići svijest

Prikaz broja smrtnih slučajeva u saobraćajnim nezgodama (izvor MONSTAT [25]) i broja suicida (izvor Uprava Policije[26] ) u Crnoj Gori za period od 2004do 2019. godine

Uzimajući u obzir rezultate istarživanja, da nasilje i povrede izazivaju velike gubitke, nastale- usled smrtnih ishoda i teških povreda, uzimajući u obzir, kako trenutne, tako i dugoročne posle dice na zdravlje djece i reproduktivno zdravlje žena, zdravlje strih osoba, posledice koje izaziva- setinamaizlozenost miliona bilo kom povrijedjenih obliku nasilja, sa privremenim gubici se na iliglobalnom trajnim nivouinvaliditetima računaju iu deformitetima, milionima života, dodat de- no uzimajuci u obzir i patnju, možemo reci da su posledoce ogromne i nedopustive. Stoga, SZO preduzima sve mjere u cilju animiranja zemalja članica da učestvuju u aktivnostima prevencije- povreda i nasilja, da izradjuju i implememtiraju strategije na osnovu dokaza, donose mjere i pred- Europeanvidjaju aktivnosti Commission na osnovu Erasmus+ egzaktnih Project: podataka | PROJECT COORDINATOR: University of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JPu cilju što efikasnijeg reagovanja i smanjenja gu Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net References • • https://www.who.int/ index.html • • http://www.who.int/roadsafety/decade_of_action/en/https://www.un.org/sustainabledevelopment/sustain- • - able-development-goals/ https://www.who.int/violence_injury_prevention/en/ • - • https://www.who.int/violence_injury_prevention/viohttps://www.who.int/reproductivehealth/publications/ lence/status_report/2014/en/violence/en/ Strategiji2009 za poboljšnja bezbjednosti u drumskom sao • • braćaju 2010-2019, Ministarstvo unutrašnjih poslova,

Evropski izvještaj o prevenciji zlostavljanja djece, - Programom2019 za poboljšanje bezbjednosti u drumskom SZO,ing-Child-Maltreatment.pdf http://www.euro.who.int/__data/assets/ • saobracajuhttp://www.mrs.gov.me/biblioteka/strategije, 2020-2022, Ministarstvo unutrašnjih poslova,Strate- • pdf_file/0019/217018/European-Report-on-Preventhttps://www.who.int/publications-detail/world-report- on-ageing-and-health planom 2017-2021, Ministarstvo rada i socijalnog staranja • https://www.who.int/publications-detail/prevent- • gijahttp://www.mrs.gov.me/biblioteka/strategije, za prevenciju i zaštitu djece od nasilja sa akcionim Strategija ing-child-maltreatment-a-guide-to-taking-action-and-gen- erating-evidence i socijalnog staranja • https://www.who.int/publications-detail/global-re- • zaštite od nasilja u porodici 2016-2020, Ministarstvo rada port-on-drowning-preventing-a-leading-killer • https://www.end-violence.org/protecting-children- • https://www.who.int/health-topics/road-safe- https://www.who.int/violence_injury_prevention/en/during-covid-19-outbreak • https://apps.who.int/iris/bitstream/han- • https://apps.who.int/iris/bitstream/han- dle/10665/331699/WHO-SRH-20.04-eng.pdf?ua=1 ty#tab=tab_1 - • - - lence/workplace/en/ dle/10665/44122/9789241563840_eng.pdf;jsessionquence=1 • https://www.who.int/violence_injury_prevention/viohttps://www.who.int/emergencies/diseases/novel-coro- • id=510E60A75D54759 8C224D1FEBD67DB7E?se navirus-2019/advice-for-public/healthy- parenting • MONSTAT, https://www.monstat.org/cg/page. • https://www.who.int/violence_injury_prevention/road_ php?id=36&pageid=36 safety_status/2013/en/ • - • https://www.who.int/violence_injury_prevention/road_https://www.who.int/publications-detail/global-status- vapolicije/naslovna safety_status/2015/en/report-on-road-safety-2018 Uprava Policije Crne Gore, http://www.mup.gov.me/upra European Commission Erasmus+ Project: | PROJECT COORDINATOR: University of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net PREVENCIJA I REHABILITACIJA KARDIOVASKULARNIH BOLESTI

Tijana Lučić Tara d.o.o Trebinje

Kardiovaskularne bolesti (KVB) danas su sve- lednjih godina jer postoje čvrsti dokazi o učinku rasprostranjenije, pri čemu poprimaju razmjere primarne i sekundarne prevencije. Utvrđeno je iglobalne prevremene epidemije. smrtnosti Vodeći do su 65 uzrok godina obolijevan starosti. da fizička aktivnost ima snažan i koristan efekat- ja u svijetu, radne nesposobnosti, apsentizma po ljudsko zdravlje, naročito u patogenezi bolesti- - koje sačinjavaju metabolički sindrom, gdje spada Savremeni stil života u kome nema dovoljno fizičke ju i KVB. Fizička aktivnost svrstava se u multifak- aktivnosti, prepoznat je kao jedan od glavnih fak torski koncept, koji uz redukciju rizikofaktora,- tora rizika za zdravlje i nastanak KVB. Fizička diovaskularnepromjenu životnog bolesti stila su i medikamentoznu sve rasprostranjenije terapi i neaktivnost odgovorna je za loš kvalitet zdravlja,- predstavljajuju vodi smanjenju veliki kardiovaskularnog socio-medicinski i rizika.ekonomski Kar nepotrebna razbolijevanja i prerano umiranje. - Kardiovaskularne bolesti su bolesti srca i srča no-sudovnog sistema, a glavne kliničke mani- problem, pri čemu poprimaju razmjere globalne festacije se mogu podijeliti na one koje zahvataju:- epidemije. Bolesti srca i moždani udar najveće su- srce i srčano-sudovni sistem – koronarna (ishem- la)ubice. i prevremene One su vodeći smrtnosti uzrok doobolijevanja 65. godina u starosti. svijetu, naična) bolest bolest; perifernih mozak i arterija.moždani Ukrvotok osnovi –svih cerebro ovih radne nesposobnosti, apsentizma (odsustva s pos vaskularna bolest; donje ekstremitete – okluziv Početkom XX vijeka na KVB otpadalo je oko 10%- bolesti najčešće je ateroskleroza, odnosno suženje- obolijevanja i smrtnosti, a početkom XXI vijeka krvnog suda. Funkcijom srca i srčano-sudovnog procenat se povećao na oko 30%. Posebno zabrin sistema održava se tok krvi potreban za očuvan java činjenica da se u nerazvijenim zemljama taj je homeostaze raznih tkiva u tijelu. Krv mora da- procenat kreće i do 60%, a u zemljama u razvoju- prenosi hranljive sastojke iz organa za varenje, čak do 82% .Prema podacima republičkih zavoda otpadne materije u bubreg, itd. Ipak, najvažni za statistiku procenatPrema DALY smrtnosti (engl. uDALY zemljama – Disability regio je je prenošenje kiseonika i ugljen-dioksida. To- na je vrlo visok i kreće se od 49,6 do 58,4% . vanjeje najhitnija ili nedostatak aktivnost, snabdijevanja jer se kiseonik kiseonikom, ne može - skladištiti, bar ne u pravom smislu, pa snabdije- Adjusted Life Years – zbirna mjera koja označava broj izgubljenih godina života zbog prerane sm obično predstavlja kritični faktor kod svakog du rti i onesposobljenosti) da je fizička neaktivnost gotrajnog rada. Fizička aktivnost dugo nije bila- vodeći faktor rizika nastanka KVB u Srbiji (Tabela priznata u smislu prevencije i rehabilitacije KVB. 2). Slična slika stanja faktora rizika je i u ostalim Međutim, značajne promjene odigrale su se pos državama regiona. European Commission Erasmus+ Project: | PROJECT COORDINATOR: University of Donja 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net - - - - Uzročnici rizika na koje se ne može uticati su sta pumpalo krv pri svakom srčanom otkucaju. Ispi rost i pol (muškarci iznad 45 i ţene iznad 55 go- tivanja su pokazala da sve kardiovaskularne boles- dina) i pozitivna porodična anamneza (naslijeđe). ti imaju koristi od fizičkih aktivnosti, pod uslovom Prema podacima Svjetske zdravstvene organizaci- da je bolest pod kontrolom. Suprotno, fizička neak- je (SZO) procjenjuje se da je fizička neaktivnost- tivnost je značajno povezana sa starenjem srca,- uzrok 5‒10% ukupnog mortaliteta u regionu (za kao i sa prekomjernom tjelesnom težinom, šećer visno od države) i da dovodi do gubitka 5,3 mil nom bolešću i povišenim krvnim pritiskom. Svjets cjelinuiona godina navode zdravog da jedna života od pet godišnje osoba zbogne praktikuje prerane ka federacija za srce, zajedno sa svojim članicama,- smrtnosti i smetnji. Podaci za evropski region kao- ističe da se 80% prevremene smrtnosti uslijed bolesti srca i moždanog udara može spriječiti kon nikakvu fizičku aktivnost, kao i da je fizička neak trolom• faktora rizika. Redovna fizička aktivnost tivnost izraženija u istočnom dijelu Evrope . Sa pomaže• da se: - pozicije savremenog sedanternog čovjeka (homo uspori sužavanje arterija srca i mozga, sedens), kojeg obilježava hipokinezija, preobilna • popravipodspiješi nivo korišćenje/potrošnja „dobrog” holesterola viškau krvi, „usk ishrana i stres, fizička aktivnost nameće se kao • ladištenih” masnih naslaga, - realna potreba u održanju života. Nesporno je da- hipokinezija u dječjoj dobi šteti biološkom rastu -i • smanjiodržava visok normalan krvni nivopritisak. šećera (glukoza), kon razvoju, u odrasloj dobi šteti zdravlju, dok je neak trolišući šećernu bolest, tivnost u starijoj dobi najčešće fatalna. Uticaj doz irane i sistematske fizičke aktivnosti je višestruka. Sistematski fizički trening doprinosi poboljšanju- ukupnog biomotoričkog, morfološkog, mentalnog- skularnih,i fiziološkog pulmonalnih, stanja. Pomoću kardiovaskularnih fizičke aktivnosti funkci mo- jaguće i autonomnog je poboljšanje nervnog metaboličkih, sistema. periferno-mu

Mehanizmi uticaja fizičke aktivnosti na kardio vaskularni sistem ogledaju se u smanjenoj srčanoj frekvenciji i smanjenom radu simpatikusa, što vodi redukciji potreba za kiseonikom pri istom naporu i time ekonomičnijem radu srca. Srce je mišić koji European Commission Erasmus+ Project: | PROJECT COORDINATOR: University of Donja zahtijeva neprekidnu aktivnost kako bi efikasno 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP Gorica This project has been funded with support from the | Donja Gorica, 81 000 Podgorica, Montenegro European Commission. | http://www.udg.edu.me This publication [communication] reflects the views | [email protected] only of the author, and the Commission cannot be | Tel:+382(0)20 410 777 held responsible for any use which may be made of | Fax:+382(0)20 410 766 the information contained therein | PROJECT WEBSITE:www.ph-elim.net Imajući sve to u vidu SZO je u svojoj rezoluciji 2000. života, jer ona u svim područjima znatno povećava godine afirmisala fizičku aktivnost kao ključni faktor ukupni kvalitet života. Rizik nastanka komplikacija u prevenciji i kontroli hroničnih nezaraznih bolesti. u toku fizičke aktivnosti je zanemarljiv, naročito ako Polazeći od prethodne premise SZO insistira na strate- se kao vid te aktivnosti upražnjava hodanje. Pravilno giji koja obezbjeđuje nadzor nad epidemijom KVB, a dozirana fizička aktivnost je potpuno bezbjedna za koja se zasniva na realizaciji: 1. programa sprovođenja većinu ljudi. zdravog načina života (nepušenje, pravilna ishrana, redovna tjelesna aktivnost). 2. programa prevencije (za osobe sa povećanim rizikom, rano otkrivanje bolesti i primjena savremene dijagnostike i terapije). Poseban doprinos u tom pogledu ostvaruje Svjetski dan srca manifestacija od opšteg društvenog značaja, koja se od 2000. svake godine obilježava u cijelom svijetu sa ciljem da se poveća nivo svijesti stanovništva o tome da se obolijevanje i umiranje od kardiovaskularnih bolesti može spriječiti uvođenjem zdravih stilova života. Na taj način mogu da se produže produktivne godine života radno aktivnog stanovništva, smanje troškovi liječenja i ekonomske posljedice. U tom cilju preporučuje se širok dijapazon različitih aktivnosti, kao što su šetnja, pješačke ture, trčanje, preskakanje konopca, fitnes, javne tribine, naučni skupovi, izložbe, koncerti, sportska takmičenja, itd. Redovna fizička aktivnost kod mladih vrlo je važna za njihov rast i razvoj, njihovo zdravlje i sposobnost, kao i prevenciju razvoja rizičnih uzroka koji utiču na njihovo zdravlje. Poznato je da je tjelesna aktiv- “FIZIČKA AKTIVNOST MOŽE ZAMIJENITI nost značajna u prevenciji poremećaja lokomotor- MNOGE LIJEKOVE, nog aparata, gojaznosti, blage arterijske hipertenzije, ALI NI JEDAN LIJEK NE MOŽE ZAMIJENITI šećerne bolesti, bolesti disajnog i kardiovaskularnog FIZIČKU AKTIVNOST.” sistema, u čijoj je osnovi ateroskleroza, prvenstveno koronarne bolesti srca. Fizička aktivnost daje odlične rezultate i kad se bolest srca već razvije. Vježbanje pre- venira i razvoj osteoporoze, a time i preloma kostiju kod starijih osoba, posebno žena. Posebno je značajno u borbi protiv depresije, a kod starijih ljudi produža- va trajanje nezavisnosti od tuđe pomoći. Nikada nije kasno redovnu fizičku aktivnost usvojiti kao način

Onlajn časopis »Sve za zdravlje- Zdravlje za sve«

God. 3, br. 9, maj 2020.god. web:Izdaje: http://ph-elim.net/national-center-for-public-health-education-phedume/ Centar za edukaciju u oblasti javnog zdravlja u Crnoj Gori e-mail: [email protected]

Kontakt:Glavni urednik: [email protected] Prof. dr Milica Vukotić