World Health Organization, Podgorica Institute of Public Health, Podgorica
Montenegro
Health Talks 14/2000
Health Co-ordination Meeting Summary
Date: 27 July 2000Location: Institute of Public Health (IPH) Podgorica
Co-chairing by:
Dr Boban Mugosa, Head of Epidemiological Unit-IPH, Podgorica
Dr Maria Cristina Profili, HOSO - WHO Sub-Office, Podgorica
Consecutive interpretation:
Dr Mira Jovanovski – Dasic, HA - WHO Sub-Office, Podgorica
Minutes by:
Ms Nicole Mullane, P.R. officer, WHO Office, Belgrade
Dr Mira Jovanovski – Dasic, HA - WHO Sub-Office, Podgorica
Dr Maria Cristina Profili, HOSO - WHO Sub-Office, Podgorica / Attendance:
Institute of Public Health, Podgorica (IPH);
Coordinating Committee for Voluntary Service (COSV);
International Committee of Red Cross (ICRC);
International Federation of the Red Cross (IFRC);
Intersos (INTERSOS);
International Medical Corps (IMC) Belgrade;
International Rescue Committee (IRC);
Malteser Hilfsdienst (MHD);
Office for Coordination of Humanitarian Affairs (OCHA);
Pharmaciens Sans Frontiers (PSF);
SOS Roma center (SOS)
United Nations High Commissioner for Refugees (UNHCR);
World Vision International (WVI);
World Health Organization (WHO);
Main Topics:
Epidemiological profile up-date;
Health access for IDPs and refugee population; Humanitarian agencies – update of activities
Dear “Partner in Health”: “Efficient and effective humanitarian assistance requires good communication and coordination of efforts of all subjects involved. Your collaboration is highly appreciated, in order to support the exchange of information among agencies, to assist you in identifying priority areas to whom your assistance would be most beneficial, to easily identify possible gaps and beneficiaries where your activity could be effective and helpful”. Comments and suggestions to this format of Health Talks are welcomed.
1. Introduction
Dr Maria Cristina Profili and Dr Boban Mugosa welcomed all attendants. The following people were introduced to the forum:
Ø Mr Davide Frigo, representative from International Medical Corps (IMC). IMC is operational in Serbia, providing health assistance programs. The agency is now evaluating the feasibility of expanding its activities into parts of Montenegro;
Ø Dr Danica Masanovic, the Head of Sanitary Inspection Department for Montenegro;
Ø Dr Zoran Vrantica, Microbiologist of IPH;
Ø Dr Mirjana Lakcevic, Chief of General Practice (GP) and also responsible for the GP Health Unit at Konik camp.
2. Epidemiological profile of Montenegro – update (IPH)
Ø Dr Boban Mugosa reported a stable epidemiological situation over the past month. Detailed data will be provided at the next meeting.
3. Konik Camp - Sanitary situation
Dr Masanovic presented feedback from a series of sanitary inspections of Konik camp. She outlined the general conditions in the camp:
Ø Estimated population of 2,800-2,900 (however figures fluctuate due to high mobility of residents).
Ø Families (averaging 6 persons) are housed in barracks accommodation. Some families have individual garbage disposal facilities, but not all.
Ø Two large reservoirs exist to maintain a water supply during dry periods.
Ø Sanitary standards in the camp are inadequate.
Ø The epidemiological situation is stable, but there are cases of hair lice.
The four key recommendations for addressing health and hygiene problems in the camp are:
1. Registration of all new arrivals to the camp;
2. Regular cleaning of sanitary blocks;
3. Regular disinfection of shower facilities;
4. Provision of adequate numbers of hard garbage containers for use in the camp.
Ongoing sanitary inspections are advised on a regular basis.
NGOs raised some broader sanitation concerns:
WVI representative highlighted the presence of garbage waste sites in and around Roma camps in Niksic, and insect infestations in these settlements. A request was made for cisterns to be provided to camps in the Niksic area, as sanitary problems are attributed to a lack of water supply over the last 3 months.
Dr Masanovic advised agencies that these issues should be directed to the sanitary inspections unit to address.
4. Konik Camp: Health situation reports, July 1st – 26th
IPH: Dr Zoran Vrantica outlined the epidemiological situation in the camp:
Ø 46 communicable diseases were registered, 16 of which occurred in children up to 5 years of age. The profile of disease was: New TB cases (4); Food poisoning (3); Tapeworms (2); Chicken pox (1); Scabies (7); Diarrhoea (29) [analysis was negative for salmonella, shigella and other pathogenic bacteria for children].
Ø Epidemiological research is being carried out in families where a member has TB. Cases that were detected in June were not reported until July, resulting in some delay in the study.
Ø Problems with water resources have been addressed by installing cisterns, and improving the hydraulic system.
The two major problems in the camp are hygienic issues:
Ø Water discharge close to the sanitary blocks. This is a building problem and should be solved through repairs.
Ø Garbage removal – it was suggested that this could be managed by improved organisation of the camp population.
In response to a query about antibiotic resistance among TB cases, Dr Vrantica replied that all current cases are hospitalised and undergoing anti-TB treatment. Some microbiological investigations are being conducted but the time for isolation of bacteria and the resources for testing antibiotics sensitivity are issues.
INTERSOS:
Ø From 1-27 July there were 1516 consultations, 949 in the General Practice Unit and 471 in the Paediatric Health Unit (primarily respiratory infections).
Ø On July 19th medical staff from ICRC Belgrade visited the camp to assess whether ICRC would support Ambulanta activities from September 1. INTERSOS recommended that Ambulantas should continue to exist due to the high number of patients covered by the service, the special nature of Roma populations, and the need for on-site health supervision of the Roma people.
Ø Health education conducted in the Baby Care Centre is ongoing and follows the ACF approach.
Ø A workshop will be held in Konik II on July 28th to train educators for the health education programme.
Ø The Konik I patients in Brezovik hospital are doing well. Their family members are sent to TB outreach in order to check their health status with respect to TBC. IRC are assisting with provision of medications.
Ø The 3rd round of barrack-by-barrack health monitoring is occurring and the updated list of chronic disease cases will be sent to WHO.
5. Konik Health Unit and patient transport services (PTS)
A separate meeting was held on July 14th to discuss the future of Ambulanta and PTS services. The minutes from this meeting have been distributed to agencies, and copies are available from WHO. Conclusions of the meeting are reported below:
Conclusions:
Konik camp / Health Units:
Ø An evaluation of the services provided by the Health Units in the Konik camp will be provided by IPH before the middle of August.
Ø ICRC medical coordinator will assess the possibility of supporting the Health Units.
Ø No final decision has been made regarding the possible extension of the health service in Konik camp. A further meeting is required asap.
Patient transportation service (PTS):
Ø ICRC medical coordinator will assess the possibility of supporting some of the PTS.
Ø WVI should find local partners to continue the PTS services.
Ø COSV should review the agreement with the DZ of Niksic regarding the donated vehicle.
Other health services/health education:
Ø The Humanitarian Agencies are covering this area according to their plan of action.
ICRC assessment and recommendations:
Konik camp / Health Units:
Ø The Health Units are considered necessary, but the current service level should be reduced by around 50%. Two doctors and 1 nurse should attend for 2-3 hours daily, 5 days per week, (i.e.: no weekend cover) and the Epidemiologist attend one day per week. The medical coordinator’s work could be reduced by 50%, resulting in a 50% budget reduction
Patient transportation service (PTS):
Ø This service is not considered necessary for ICRC funding support. ICRC concluded that a daily service for the camp did not appear to be justified. The review identified some misuse/overuse of the transport system. ICRC suggested that a broad analysis of the transport needs throughout the whole country and in other camps is indicated, to fully assess needs and target inputs most appropriately. The ICRC representative stressed that the organisation will not take over the PTS project, but will look at written proposals put forward from agencies to act in partnership. ICRC would prefer that the Montenegro Red Cross society or a local organisation take on this service.
Discussion took place around these issues. The Key points are presented as a summary:
· Dr Mugosa posed the following questions: How much consideration has been given to the number of cases seen within the current working hours, and how these service demands would be met if hours were reduced? How patients without financial resources would access hospital services? How the current stable situation would be affected by reducing resources and services?
· The ICRC assessment was an internal evaluation, according to the Committee’s standards. Consequently it reflects ICRC’s estimation of the situation and recommendations, and is open to further discussion. Patients in Ambulantas and World Vision were consulted in the process.
· As the situation stands, all PTS for Konik camp will cease at the end of August.
Dr Mugosa stressed that there are around 10,000 people in the surrounds of the Konik camp (including those in private accommodation and shanty towns) who rely on services in the camp. The focus on the needs of Konik camp relate to its large population, however Dr Mugosa agreed that the whole situation in Montenegro should be evaluated. He advocated further discussion regarding the ICRC report recommendations and suggested that ICRC and another organisation could share in supporting this programme. Dr Mugosa planned to meet with UNHCR in the following week to request assistance in this area.
· COSV – funding for transport assistance for the settlement in Niksic, was extended to cover the winter period, but the project will cease at the end of July. Some further discussion with the Director of Niksic DZ s should take place for the extension of the service to the Roma population.
· Dr Profili expressed concern that NGOs programmes have favoured health education/training activities for IDPs population, with a lack of interest in supporting patient access to health services. While the situation remains in the emergency phase, basic health needs, including health access, should be the priority. It is essential that sick and vulnerable categories of people, particularly those located in remote areas, can reach health services. Dr Mugosa agreed that whilst health education programmes are valuable, the priority must be assessing and treating ill patients.
· Dr Lakcevic, who is the Chief of General Practice team and works at the Konik camp, attributed the present standard of health in the camp to the level of service the teams have been able to provide. Currently a high number of consultations occur, there is no waiting period, and patients receive effective screening and treatment. This prevents inappropriate referrals to other levels of the health system, and limits the need for patients to use hospital services. Dr Lakcevic stated that the ICRC report recommendations place the health standards of the camp at risk, and that any service change should be carefully considered. She recommended a minimum service cover of 7 days a week, with 4 hourly morning and afternoon sessions.
6. Other IDPs health services:
Camps in the Tivat municipality:
Ø Dr Nikola Radoman who works with COOPI, reported that the conditions in the coastal settlements were significantly worse than in the Konik or Niksic camps. The situation in the Tivat camps has not improved since November, with more than 200 people living in wooden barracks (9sq metres) with no electricity or running water.
Ø The main problems are garbage removal and hygiene issues related to waste sites, toileting beside the artificial lake, and pollution of the drinking well. Dr Radoman stated that humanitarian agencies have shown little interest in these camps.
Ø COOPI has run a psychosocial programme and a school programme, and the Refugee Trust assists with supply/control of water. As there are no health services within the camp, COOPI purchased a vehicle to transport patients to health facilities. However four weeks ago they received notification that funding for transport would cease at the end of August.
Ø Dr Radoman stated that discontinuing PTS would obstruct patient access to Dom Zdravija services, due to cultural and financial constraints. He also asked agencies to assist with the problems of water supply and hair lice in the camps.
Ø Dr Mugosa commented that the above description is in line with the recent report on the Tivat camps produced by Dr Jovicevic.
7. Other health services:
Patronage/Home care services:
Ø IRC is involved in supporting patronage services in parts of Serbia. Matt Ward, the medical coordinator of IRC Belgrade, asked whether this type of programme assistance had been considered in Montenegro as a means of improving access to health care and establishing outreach services to remote communities.
Ø Dr Profili responded that after the Kosovo crisis the focus in the emergency phase has been on establishing health access/patient transport systems, to respond to the influx of patients into the health care system and to avoid creating mobile teams in the camps.
To date there has been no similar programme of mobile homecare support/patronage in Montenegro. IMC and CARE have recently expressed their interest in supporting this kind of service in Montenegro. Dr Profili stressed that in this transition phase, the focus should be upon reinforcing the local primary health care services, which all the population can access (including IDPs ), thus avoiding the creation of any parallel health system.
8. Humanitarian Agencies – Update of activities
SUPPLY of DRUGS and MEDICAL EQUIPMENT
REHABILITATION of HEALTH FACILITIES
Coordinating Committee for Voluntary Service (COSV)
Ø Rehabilitation of buildings finished for July.
Ø Drugs donations are continuing on a monthly basis.
Ø A copy of the drugs distributed in June is available from the agency.
International Committee of Red Cross (ICRC)
Ø Continued delivery of surgical items in the hospitals– started distribution in Bar, Niksic and Podgorica (3rd shipment).