WORLD HEALTH ORGANIZATION
Kosovo Health Talks 29
9
26.07.2000
NEWS UPDATE
HEALTH AND SOCIAL WELFARE
Cuts, downsizing postponed
Proposed cuts of 15 per cent in the Health Service payroll, planned to be effective by the end of July, have been put off by at least one month. However, some cost-cutting measures, such as adjustments to pay scales and some early retirements, will proceed.
The cuts could have led to substantial downsizing, and the plans had caused concern in some quarters. The postponement will allow more time to decide what is required for the right size of the health workforce, and what is affordable.
The delay will be used by the DHSW to review once again the numbers of specialists, GPs and residents. There will be a special study of staffing in health houses and of dentists.
Regional directors have been asked to use the extra time to decide carefully how many administrative and support staff are needed.
Meanwhile the freeze on recruiting continues.
DHSW co-director Pleurat Sejdiu told a special meeting of regional health management teams on Monday that he had withdrawn his resignation, offered last week, because of weekend meetings with the administration that had resolved his concerns "in a positive manner".
At issue were the cuts in the budget and the staff reductions which "will now take place only where really needed."
Detailed staff reviews have been taking place throughout Kosovo over the past two
weeks in anticipation of the cuts. Attila Perczel, officer in charge of the DHSW, thanked everyone concerned and said that the review should be "considered as a management training activity".
"Directors now have a clearer picture of staffing needs," he said. "We started with money, and not the number of staff to be dismissed. Also we gave a final decision to local directors."
WHO Human Resources consultant Stephen Briscoe told the meeting that "the delay gives you time to decide what is right for the service. In health houses we found not only overstaffing, but understaffing as well. This is an opportunity for you to plan rather more sensibly."
Dr Sejdiu reminded the meeting that the general rule in the meantime was that no one will be paid unless they are working.
Family doctor specialisation approved
Pleurat Sejdiu, DHSW co-director has announced that the family doctors specialisation has now been approved. The family doctors training programme was launched at the beginning of July in training centres in Gjakovë/Djakovica, Pristina and Gjilan. (see article p8)
Donors need convincing on future plans
The health sector has to persuade donors that plans are serious and that every D-mark of donor money will benefit the people of Kosovo, Roy Dickinson, director of the Department for Reconstruction's spending programme, told regional health management teams on Monday.
Mr Dickinson said that "last year we had to prepare Kosovo to get through the winter. This year we have to prepare for the next ten years. And there is less money around."
He said that the Department of Health and Social Welfare had to propose plans, the Department of Reconstruction would consider them and then the SRSG, Dr Bernard Kouchner, would have to approve them. "But donors have the final word and may not agree on the same priorities."
"The health programme is not being fully funded by donors at the moment," Mr Dickinson said, "so next year we will still be looking for new money."
He said there was a need for better information about the needs, about what donors are doing so far and what is planned in the health sector.
There were three parts to the search for new funds, he said.
First came a global strategy. People had to look at the long term, to make sure that "we are implementing sustainable policies and that we are clear that we know exactly what results we expect over three to four years of investment." The administration had to argue that "we need this investment because this is what we want to see in five years," and not just that money was wanted for this or that project or piece of equipment. A team of experts is expected in Kosovo next week to work on a "comprehensive development framework".
Behind the global strategy came the articulation of a limited number of spending programmes, broken down into sectors such as primary healthcare or pharmaceuticals. This should produce a number of clear programmes in DHSW, he said.
Finally came specific projects which support the overall objective. Here the lowest level, the health houses and ambulantas, could make some careful costing of carefully designed projects.
Mr Dickinson said that when all this was done "we will have a public investment programme in all sectors for the next three years.
Mr Dickinson said that his remarks applied equally to other departments in the Joint Interim Administration.
HEALTH POLICY
Draft policy document nears completion
The development of the policy guidelines by the Policy and Planning working group appointed by the DHSW met on a weekly basis during the past three months. These sessions included a partial review of the theory of health policy and planning. The situation in the health sector of Kosovo compared to relevant countries was reviewed and studied
The “Interim Health Policy Guidelines”, or "Blue Book", provided the starting point and each section was reviewed and discussed intensively. Consultations were held in each region as well as with stakeholders based in Pristina, including the University Clinic Centre, the Medical Faculty, Dental Association, pharmaceutical sector, local and international NGOs and representatives of the international community. Opinions were expressed freely, but in a constructive fashion. One meeting was held through WHO with a group of ethnic Serbian doctors in Mitrovica Hospital but similar meetings elsewhere were cancelled for various reasons.
The document will be submitted to the DHSW by the end of this month for further review. It will then be presented to the international community, including donors, for consultation.
Dental Consultant visits Kosovo
Time constraints meant that WHO consultant Dr Walter Mautsch was able to stay for one week only during his visit this month to get an overview of oral health in Kosovo. He also gave technical advice to the Oral Health Working Group on developing terms of reference. The working group, set up by DHSW Dental Officer, Dr Blerim Kamberi, consists in the main of senior professionals at the staff of the Dentistry Faculty in Pristina.
At the moment the working group is preparing questions for the assessment of dental equipment throughout Kosovo, including essential dental equipment and basic dental supplies. Dr Mautsch is expected to return in August.
CHILD HEALTH
Architects study maternity problems
Visiting medical architects have recommended urgent rehabilitation of Pristina University Hospital maternity. WHO consultants Ahmet and Florence Gulgonen, in a preliminary report, said that there were three main priorities: waterproof isolation of the roof, improved water supply, and canalisation and toilets.
The maternity building, built in 1981, seemed to be in good condition from the outside but the interior had been neglected and had many deficiencies, the report said.
"Rehabilitation is an urgent need. What is equally evident is that it should be made with the least disturbance possible."
The corrugated metal roof, installed four years ago, had been damaged and was holed, the report noted. "This is a very urgent problem which should be solved before winter."
The water shortage problem, caused by low urban water pressure and an inadequate roof tank, "is the most urgent problem and the solution should be found without delay."
The two architects, who are to submit a more detailed report before they return to Kosovo later this year, noted that there is a general problem with toilets, canalisation and water pipes. They recommended that "for hygienic reasons this problem should be solved urgently."
COMMUNICABLE DISEASES
Six months figures released
61,200 cases of communicable diseases were reported by healthcare facilities (primary and secondary healthcare) to the Institute of Public Health (IPH), Pristina, during the first six months of 2000. The most common syndromes were lower respiratory tract infections (LRTI - 21,509 cases) and acute diarrhea (13,191 cases). The highest number of reports on LRTI came from Pejë/Pec municipality with 3,197 cases; while the highest number of acute diarrhea is from Pristina municipality with 2,752 cases.
Table 1: cases by age group
Disease/Age / <5yrs / 5-49yrs / 50+ / TotalAcute diarrhea / 5793 / 6046 / 1352 / 13191
Int. parasites / 1025 / 1751 / 186 / 2962
LRTI-Pneumonia / 5761 / 11228 / 4520 / 21509
Scabies / 1858 / 6195 / 1138 / 9191
Varicella / 2068 / 2690 / 31 / 4789
Total / 16505 / 27910 / 7227 / 51642
Outbreak investigation and response
Tularemia: more than 200 suspected cases (out of 800 reports) and a number of asymptomatic individuals were found seropositive for tularemia by 2 May. Preliminary statistical analysis indicated as most likely explanation for the epidemic a dormant focus of tularemia in Kosovo. Mass exodus and destruction during the war led to an excess of food in houses and unharvested crops. Rodent populations exploded and infected rodents contaminated water and food in human settlements. Given the route-specific clinical presentation, water sources may be considered the more likely source of human infection. Control measures including strengthened surveillance, health education and ensuring safe water are being promoted.
Mumps: An increased number of reported cases of mumps initially from Malisheva/Malisevo municipality was detected in November last year. Reported cases tended to increase, with a peak in May. The total number of cases reported for the six months period is 5,467. The highest number of cases was from Prizren region 40 per cent of all the cases reported),
Probably, the higher number of reports reflected the increased awareness of both population and medical staff, as well as the strengthened surveillance since the Tularemia outbreak. However, the vaccination program during the last years was interrupted by the political events. There has been frequent shortage of the Mumps component on the MMR vaccine during the last ten years.
Response: The IPH has strengthened its immunization activities together with programs on health education and promotion. Organizing an additional vaccination campaign against Mumps, Measles and Rubella is being considered.
Measles: Number of cases reported for this period was 1272, which is significantly higher than in the previous years. Measles prevention as part of general EPI is one of the top priorities for the IPH.
Brucellosis strikes two villages
Brucellosis is endemic in Kosovo and since 1985 there have been 1,233 cases, with 58 per cent of the cases in the Prizren region. This year there have been 63 recorded cases, most of them sporadic. However investigations are now underway into limited epidemics in two villages, in the munici-palities of Gjilan/Gnjilane (10 cases) and Shtimë/Stimlje (eight cases).
Home made cheese is the most probable source of infection in Gjilan, while contact with blood and tissue of a slaughtered sheep is the most probable source of infection in the second case.
Control measures have been implemented in both villages, and a health education programme on brucellosis is being prepared for all Kosovo. At present there is no vaccine available to immunise goats and sheep as veterinarian services are not yet established.
Haemorrhagic Fever: one patient has been confirmed positive for Crimean Congo Haemorrhagic Fever (CCHF), in June 2000. A 17-year-old from Malisheva/Malisevo municipality was referred from Gjakovë/ Djakovica hospital to the Infectious Disease Unit of Pristina University Hospital as suspected CCHF on 1 June. The patient recovered and has been discharged home. The sera samples were tested at the Bernhard Nocht Institute for Tropical Diseases in Hamburg. Four family members were tested, although none showed symptoms of CCHF. Results are still pending.
Acute Flaccid Paralysis (AFP): A child of 16 months from Poterc/Klina municipality was reported by the Infectious Disease Clinic, Pristina on 28 June as suspected AFP. Preliminary results were negative, but two further passages in cell culture are needed.
Table 2. cases of diseases with high epidemic potential
SYNDROME / CASESAcute Flaccid Paralysis / 1
Acute Jaundice Syndrome / 1397
Bloody Diarrhea Syndrome / 50
Haemorrhagic Fever Syndrome / 1
Meningitis Syndrome / 116
Other Infectious Diseases / 1648
Susp Epidemic Parotitis-Mumps / 4924
Susp Measles-Rubella / 1128
Susp Pertussis-Whooping Cough / 274
PUBLIC HEALTH
Epi-Info course completed in Pristina
From the 4 to 7 July the International Rescue Committee, using ECHO funding and in co-operation with WHO, held a computer training course in Epi-Info, a statistical package developed by the Center for Disease Control (CDC) in Atlanta, which is used worldwide for the collection and analysis of epidemiological data. Twenty four epidemiologists and public health specialists from all the regions - Mitrovica, Peië/Pec, Prizren, Gjakovë/Djakovica, Ferizaj/Urosevac, Pristina and Gjilan/ Gnjilane - attended the four-day course.
Mike Ryan, WHO Geneva, led the training team of six specialists who came from the United Kingdom and WHO Copenhagen. Epi-Info will be used by the Institute of Public Health for its communicable disease surveillance system, which is currently being established. The training will also assist epidemiologists in investigating disease outbreaks in the community and enable them to carrying out routine surveys to establish the health status of the population.
Position of Prof. Boshnjaku confirmed
Professor Shkender Boshnjaku has been re-appointed director of the Institute of Public Health (IPH) in Pristina. The Department of Health and Social Welfare announced confirmation of the appointment on 1 July. Prof. Boshnjaku has been Director of the Institute since June 1999 and will be leading IPH during a crucial period of restructuring and strengthening of public health services in Kosovo.
HOSPITALS