1. The International Conference on the Future of Primary Care in Europe Policy Dialogue as a Way for Making Better Primary Health Care Policy Institute of Public Health of Serbia
Mirjana Živkovic-Šulovic, MD
Prof. Orvill Adams, Project Director
Miodrag Stefanovic, MD, MPH
Southampton, 15.-17. September 2008.
2. Institute of Public Health of Serbia “Dr Milan Jovanovic Batut” http://www.batut.org.yu
3. Republic of Serbia -Health Care in Permanent Transition- Population (2006.) 7.411.569
Life expectancy on birth:
male 70, female 75
Birth rate 9.6
Natural increase rate -4.3
Vital index 69.0
Infant mortality rate 7.4
Total expenditure on health care per capita 185 €
Out of Pocket payments app. Annual per capita 170 €
Health care service employed 108.975 persons, ¼ with university education.
Medical doctors 19.688
36% doctors are in primare care
The average population per doctor in PHC 1049
4. Primary Care Providers: Chosen Physician MD or spec. GP, occupational medicine
For adults 18+
Preschool and school children (0-18)
5. Balkans Primary Health Care Policy Project www.canbhp.org Serbia and Bosna and
Goals: Improved, Efficient and Effective PHC Systems
Working groups (WG):
Demonstrations Sites WG
Voice of Consumers WG
Strengthened PHC policy coordination and harmonization between civil society, stakeholders, government agencies and donors.
Improved PHC policies, inclusive of the specific needs of women and vulnerable groups.
Increased access to PHC services by vulnerable groups.
6. Definition of Dialogue (by Will Phillips) …is the interaction between people with different view points, intent on learning from one another.
The purpose of this learning is to lay the foundation for creating new solutions.
The focus is on changing oneself through the process of exploring ones own perspective or viewpoint.
Essential Elements of Dialogue
7. Policy dialogue (1) (BPHCPP) The purpose of PHC policy dialogue is to provide opportunities to discuss some of the critical issues in PHC from the perspectives of different stakeholders.
Providers (12 Dom zdravlja – 1 reference and 1 private)
Ministry of Health (officials and politicians)
Health Insurance Fund
Chambers of Health Professionals (regulatory bodies)
Representatives of Health Professionals Education Institutions and Associations (doctors and nurses)
Consumers (representatives of vulnerable groups)
Public Health Institutes
Between 60 to 80 participants
8. Policy dialogue (2) (BPHCPP) Co-operation:
Government of three countries
Professional organizations and Associations
DFID/Norway supported project of Social Protection Strategy
Balkan’s Youth and Health Project
Background paper to define the issues
Presentations from different perspectives
Discussions, Questions and options for solutions
Small groups for in depth discussion
9. Policy dialogue – Series 1 Zajecar – November 2007 (1) 1. Issues of organization change
How organizational change are affecting the operations of DZs
2. Issues of financing and provider payments
3. Issues of changing role of local government
4. Role of consumers in PHC
5. Seeking for Potential Solutions:
What do DZ want from LGs?
What do LGs want from DZs?
Strategies for responding to the concerns of consumers
10. Policy dialogue– Series 1 Zajecar – November 2007 (2) Actions from the Dialogue:
Establishment of the working group to define protocols for active cooperation (between LGs, DZs, IPH, and consumers on the municipal level)
DZs agreement for mutual support visits (friendly raids)
A proposal for a protocol on patient centered care
11. Policy dialogue – Series 2 Zrenjanin – April 2008 (1) 1. Impact of Financing on Access to PHC services
2. Availability: What are the issues of availability in Serbia?
3. Accessibility: What is the scope of this aspect in Serbia in PHC;
4. Accommodation: Organizational issues that affect access in Serbia
5. Acceptability: What are the issues facing DZs in Serbia
6. Seeking Potential Solutions for these issues
12. Policy dialogue – Series 2 Zrenjanin – April 2008 (2) Actions from the Dialogue:
Formal agreement signed by the minister of health for ongoing cooperation btw. the pilot sites
Presentation and acceptance of the proposed guide for cooperation btw LGs, DZs, IPHs and consumer reps.
Set of agreed proposals to be included in revised PHC policy
13. Policy dialogue – Series 3 Mokra Gora – July 2008 (1) Issues for the third policy dialogue
The Scope and Content of PHC Services in Serbia
Incorporating Health Programs in PHC
Patient centred care as an instrument to deliver quality care
14. Policy dialogue – Series 3 Mokra Gora– July 2008 (2) Actions from the Dialogue:
Agreement on the gaps in the scope of services provided at the PHC level
Agreement to prepare joint plan of action btw LGs and DZs for improvement of preventive services.
Increased awareness of the key issues through the media participation
15. Findings: There is increased awareness, participation and ownership by key stakeholders of PHC policy development process.
The Charter for Continued Collaborative Action has been developed by participating PHC Centers (12) and been signed by all, the Minister of Health and the Project Director.
Good practices in PHC service delivery and organization have been documented and are being prepared for wide dissemination which has contributed to the knowledge base for PHC stakeholders.
Consumer representatives have been actively involved in the Projects policy development processes.
Legitimized, active participation of key stakeholder groups in the PHC policy development process
16. Next Steps Regional Conference “The Future of PHC in the Balkans: Responses to the Challenges” in Belgrade, Serbia, 13th-14th October
Last Policy Dialogue Series 4
Preparation of a PHC Policy
Main goal for future Health Care Policy
The Primary Health Care System will be rights based, gender sensitive, client centered, accessible, equitable, efficient, safe, responsive, of high quality, sustainable and accountable.
Is this just a dream?
The policy dialogue process will make realization of the dream more likely
17. Caution ! Entering into a process of policy dialogue raises expectations of stakeholders which demands responsive actions by policy makers.
Dialogue requires careful organization and facilitation to manage the conflicting interests