NEW POLITICIANS, OLD VULNERABILITIES:
When the population of Serbia goes to the polls this Sunday, their vote will not just affect the Parliamentary deputies of the Republic of Serbia, it will ripple through all state institutions, including those concerned with health care.
This should enable some much-needed direction and action. The past few months have seen health strategies on hold and some health facilities unable to pay bills even when there is money because signing authority remained with an inactive director.
But clearing the governmental air will not have an immediate effect on the fundamental problems of people seeking health care in Serbia which are: a drained health insurance fund with virtually no current income because of high unemployment, dependence on international organizations for drugs and medical supplies, obsolete medical equipment, and very low salaries – a doctor earns only between 80 and 200 DM a month.
Last week the World Health Organization (WHO) estimated Serbia needs a total of US$341million just to keep the health service going for the next six months. The Government, WHO calculates, should be able to cover half of this – largely salaries. The rest – including drugs, medical consumables such as needles, gauze and gloves, patient food, essential maintenance, running costs and fuel – needs an urgent response from any individual or organization which would like to show their support for the new Serbia – and, in particular, for the health needs of the people there.
In practice, it is patients who currently fill this gap, buying their own medical consumables and drugs and paying something for referrals, investigations and operations. This puts health care out of reach, not just for many of Serbia’s 720,000-plus refugees and internally displaced people (IDPs), but also for the resident population, many of whom live now in equally poor health and economic circumstances.
What is becoming increasingly difficult is working out just who needs help most urgently. Much international assistance has been targeted to collective centres where refugees from Bosnia Herzegovina and Croatia have lived for as long as five years and where, in the past 18 months, internally displaced people from Kosovo have been gathered.
But while conditions in these are unquestionably difficult – cramped with stretched communal services and little privacy – in material terms, collective centre residents are now relatively better off than the majority who live in so-called private accommodation whose plight is far less visible.
“Collective centres are easy for organizations who have some money to target – they are very visible,“ says Dr Danijela Korać of the Novi Sad Humanitarian Centre, a local NGO which operates outreach medical teams under the auspices of the International Rescue Committee. "Though residents get no actual money, the state pays for running costs like heating and they get food and other things they need through the Yugoslav Red Cross which delivers international aid. But over 90% of refugees and IDPs live in private accommodation, which sounds nice, but in fact is often dark and damp and very bad – and they get no help with electricity bills or rent, and no aid."
Many of people living in private accommodation work on the grey market to pay the bills, says Dr Korać, but 80 to 90% of their income goes on rent and if a family member becomes ill, especially if it is a bread winner, what fragile stability they have collapses.
"Most of the time people in private accommodation can maintain some kind of equilibrium, but if they have to do something extra like buying medicines then they really have a problem. Often the most vulnerable people – emotionally, financially, in every way – are a family which has a sick member."
Preliminary results of a baseline health study carried out by the Institute of Public Health of Serbia and the WHO suggest there are currently high rates of under-treatment of diagnosed diseases like hypertension, anaemia and diabetes among refugees and IDPs, most likely due to difficulty in obtaining drugs that are not available in state pharmacies.
Local assessments, however, suggest that there is little difference between the health status of refugees and IDPs and vulnerable people (unemployed, elderly, socially or physically disadvantaged) among the resident population, and that international aid needs to broaden out to include the latter.
To help facilitate this, and the effective co-ordination of health assistance and public health interventions, WHO has just opened two new field offices, one in Nis and one in Novi Sad, with the help of funding from the Norwegian and British Governments.
WHO’s field officers will also provide technical public health back-up to the local health authorities and to international medical NGOs which are already focusing on vulnerable populations. Médicins du Monde Greece, for example, have focused their support on primary health care in rural areas of South Serbia, renovating ‘ambulantas’, and providing drugs and medical supplies accessible to the whole community, not just refugees and IDPs. Others, such as the International Medical Corps and International Rescue Committee, work with local staff to provide medication and basic health advice to collective centres, and outreach services into the community aimed at seeking out the vulnerable.
Whoever the vulnerable are deemed to be – one of the most urgent problems to be solved is drug supply to state pharmacies. Serbia had an efficient drug manufacturing industry but sanctions and the rock bottom prices under the previous regime have brought activity almost to a standstill. WHO has been working this month with Pharmaciens sans Frontières and the European Agency for Reconstruction in the Balkans to get essential drugs into state pharmacies by the end of the year. With over 60% of the drugs to be brought from local manufacturers, it’s hoped that this will kick-start the industry too.
A further donation to cover drugs for the coming six months is also being considered by the European Commission – though the Agency is cautioning that neither of these donations will cover all drug needs of the health service and other projects are needed to target specific groups such as insulin-dependent diabetics, haemophiliacs and the large numbers of people with high blood pressure.
A second priority identified by WHO is medical equipment – not the long ‘shopping lists’ of new equipment every health facility director now has in his or her back pocket but getting existing medical equipment working again.
In Belgrade, the City Hospital’s almost new CT scan is out of action for want of an inexpensive computer memory board, says WHO medical equipment consultant Dr Barbara Veh-Schmidt, while an autoclave that should provide the hospital with IV fluids is not working because it lacks a microprocessor which is available cheaply on the local market but which the hospital has no spare funds to buy.
Repairing equipment like this will have the immediate impact on many patients’ treatment, says WHO, which this month began a project to get existing medical equipment back to work in a number of hospitals in collaboration with international medical NGO Merlin and funded by the UK Department for International Development.
But these issues are just the short term priorities; 2001 is likely to hold a great deal more in terms of challenges for the ‘new management’ and its international partners if available aid is to be used effectively and help re-build a health service that will meet the needs of all.
For further information, journalists can contact Ms Hilary Bower, Media
Officer, WHO, Geneva. Telephone (+41 79) 249 3528. Fax (+41 22) 791 4858.
Email: email@example.com All WHO Press
Releases, Fact Sheets and Features as well as other information on this
subject can be obtained on Internet on the WHO home page http://www.who.int