Kosovo Journal:
New Health Strategy Focuses on Primary Care
By Sergei Vinogradov

Photo/Kyung Shik Chung

The cornerstone of Kosovo’s new health care system is primary health care (PHC) based on family health teams, consisting of medicine doctors, nurses and other relevant health professionals working in family health centres and punctas (small outreach health centres). In prioritizing prevention, these teams would be capable of addressing and solving 80 to 90 per cent of common health problems. People will choose a single family physician as their personal family doctor.

This is the essence of the new health policy developed by the Department of Health and Social Welfare (DHSW). The strategy envisions less emphasis on in-bed patient treatment, downsizing hospital bed capacity but aiming to provide much higher quality service.

“A modern system should involve divided responsibilities and higher qualifications of nurses and other medical support staff”, says Bengt Stalhandske, DHSW co-Director. “In general, health care systems, like the one in Kosovo, are very heavily dependent on doctors who often do the work, which in a more advanced system is done by nurses. As a result, the system loses efficiency - doctors become overloaded, nurses do secretarial jobs, although in other countries this is done by secretaries. We want to change that.”

The location and size of PHC facilities will be determined by the number of people to be served by them. DHSW will support the rehabilitation and operation of only those PHC facilities that are on its facility master plan, and they will have to adhere to standard equipment and service lists issued by the Department.

Delivery services will be available in all hospitals and initially in selected family health centres. To increase the safety of mothers and babies, deliveries will be concentrated more and more in hospitals as their capacity increases. Emergency transport will initially ensure only basic life support, but the capacity will be increased as resources permit. Essential oral health, with emphasis on promotion and prevention, will be part of PHC. Mental health services will be increasingly based in the communities. The drug supply system will ensure the availability of essential drugs.

The current general hospitals will continue to provide in-bed patient care, but access to secondary and tertiary care - cases requiring hospitalization and surgery - except in emergency cases, will require referral from PHC. Non-family health specialists will work in or be affiliated with hospitals. Rehabilitation will be an essential part of care.

The new health system will be mostly public-based, financed from the Kosovo consolidated budget, but will have a separate private component. DHSW will monitor the potential adverse effects of the private system. Some form of pre-payment or health insurance will be introduced. According to Mr. Stalhandske, it will take many years to build up the new health care system. “Our blueprint is an expert plan of how the health sector should be organized, but political factors will also come into play. Therefore, we will probably have to make a lot of compromises in our journey, and our policy may take some new angles. But the strategy should not change”, he says.

DHSW is merging with the Department of Environmental Protection to form one ministry, and the international staff will be gradually reduced. The overall role of the United Nations Mission in Kosovo (UNMIK) will change to monitoring and advising, Mr. Stalhandske notes. But the new ministry would still be in need of international expertise for some time.

Sergei Vinogradov, a member of the UN Chronicle editorial staff, is on assignment with UNMIK. He contributed this report from Pristina.