WORLD HEALTH ORGANIZATION
Kosovo Health Talks 34
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18.10.2000
NEWS UPDATE
HEALTH AND SOCIAL WELFARE
Municipalities prepare for new role
The Department of Health and Social Welfare has defined the health care responsibilities which municipalities will inherit as part of the decentralisation of power in Kosovo.
UNMIK's Regulation on Self-Government of Municipalities (No. 2000/45) states that each municipality will be responsible, among other things, for primary health care and for consumer protection and public health within its territory.
Apart from PHC, all institutions, including the hospitals, remain under DHSW.
Department deputy co-head Bengt Stalhandske notes that decentralisation covers more than the health sector, and "the DHSW way will be very different to Education, for example." The Department has to ensure that Kosovo does not end up with 30 different primary health care systems.
Areas of responsibility to be transferred to the municipalities are: health education; safe food nutrition; safe water and basic sanitation; maternal and child health; immunisation and vaccination; basic medical treatment; community-based mental health; basic oral health; and drug supply.
The key to decentralisation lies in the budget. All finance of municipal health budgets is channeled through the Central Fiscal Authority, and the municipalities will have to sign service agreements before DHSW allocates funds. Among other points, the agreement will indicate the number of posts for different categories of health workers. The municipalities will be fully responsible for recruitment and will have to resolve all problems involving salary payments.
Drugs and fuel will be purchased centrally for use in the municipalities.
A DHSW memo said that municipalities would keep 60 per cent of revenue from co-payments for fees, and send the remaining 40 per cent to the Department, which would set the level of fees, including those for examinations of UN staff.
Bengt Stalhandske told last month's General Health Co-ordination meeting that as far as policy is concerned, DHSW will define policies, develop strategies, set norms and standards and distribute guidelines. The municipalities will have to assess local needs and set local primary health care targets.
Similarly, DHSW will establish the budget framework, develop allocation models, set priorities and allocate budgets. The municipalities will develop the budget based on local needs, approve and implement the local budget, and set and collect fees.
The municipalities will provide all services within their remit, but these will be monitored and supervised by the central authority. The local authorities will implement the approved infrastructure and will have sole responsibility for hiring and firing.
Municipal elections are due to be held on 28 October.
PUBLIC HEALTH
Polio First part two
The second - and final - round of the IPH/WHO/ UNICEF Polio First campaign begins tomorrow (19 October) with immunisation teams geared up to raise the coverage rate in the six target municipalities.
The campaign, which ends on Sunday 22 October, comes only one week before the municipal elections, and members of the social mobilisation teams will be competing with political parties for air time on radio and TV and column inches in the newspapers.
The second round will benefit from lessons learnt last month when the campaign had to sprint in the final days after a slow start.
Promoting the cause: WHO regional public health adviser for Pristina region Dr Ismet Lecaj took the Polio First message to the suburbs in last month's first round of immunisation.
Food course for KPC
Hungry for knowledge: food inspectors from the Kosovo Protection Corp return to class for the one-week course.
A dozen members of the Kosovo Protection Corp's medical battalion are now on a one week course for food inspectors. The KPC candidates have joined six other health workers on this second food inspectors course organised at the central Institute of Public Health through the WHO programme. Course leaders are Rudolf Schmitt, a WHO consultant and food microbiologist from Switzerland who inaugurated the training programme in June, and Andreas Volger from Italy.
The course will cover microbiological, chemical and physical hazards, food technology and good hygienic practices as well as the organisation of food control in Kosovo. Participants will gain practical experience during visits to the Pristina University student restaurant and the Prizren milk factory.
KPC members will apply their new skills by controlling food quality in the Corp's facilities.
Drinking water course for inspectors
Municipal sanitary inspectors and heads of the regional IPH hygiene departments from Prizren, Gjakovë/Djakovica and Pejë/Pec are currently on a three-day course on drinking water inspection.
The aim of the three-day course, which is led by national and international facilitators, is to strengthen knowledge about drinking water standards and sanitary inspections in Kosovo. The course is being held in Istoq/Istok.
Ready to roll: Sarah Gayton of WHO's Environmental Health Unit stands with the flotilla of vehicles presented last month to IPH WatSan unit. The vehicles were funded by the US State Department.
ORAL HEALTH
Some progress in dental policy
Assessment forms for dental equipment and instruments have been sent to all dental establishments with the aim of getting an overview of the actual state of equipment in health houses and ambulantas. The action coincides with a month-long visit by WHO dental adviser Dr Walter Mautsch, who leaves Kosovo at the end of this week but is expected to return in January.
Lists of basic dental equipment for primary and secondary dental care have now been prepared, as well as an essential drug list for primary and secondary dental care.
During his first visit in June, Dr Mautsch prepared an action plan and terms of reference for a working group, which was set up in mid-July. This includes the DHSW Oral Health officer Dr Blerim Kamberi, Dr Vexton Hoxha, director of the University Hospital, Dr Osman Sejfija, director of the dental school and five other members, including three from the dental school, one from Pristina Health House and one from WHO. Representatives of regional health houses and NGOs working in oral health are not represented on the working group, although the Administrative Instruction setting out oral health policy earlier this year recommended that they should be included.
The working group has held only two meetings since its formation, but despite this some actions have been initiated. A team made up of a dentist, a dental laboratory technician and a technician has now visited 10 health houses and the dental school and made a rough assessment of the dental unit, dental chair and compressor; the Department of Health has released some guidelines for the provision of dental consumables to health houses; and an outline proposal for an oral health survey has been drafted.
Before the end of the week contacts with the WHO Primary Health Unit are expected to lead to the integration of oral health in proposals for training of family health nurses. A six-month action plan for oral health is also near completion.
There is still much to be done to improve oral health in Kosovo. A list of priority dental equipment needs will be drawn up as soon as the assessment forms have been returned and studied. A maintenance system needs to be established, and funds will be sought for equipment and training of technicians. Educational material has to be prepared for family health nurses, followed by training of nurses within the PHC Family Medicine programme. Guidelines and a code of practice for private and public dental services have to be drawn up, and there are plans for joint activities with Medair on a pilot preventive-promotional programme in Pejë/Pec.
Several problems still have to be resolved. These include the unequal distribution of oral health staff, the switch from curative to preventive services, the difficulty of providing maintenance for different brands of equipment given by donors, lack of data on prevalence of the most frequent oral diseases and general lack of funds.
Many donors are already involved in support for dental services in the province. GTZ, the German technical co-operation organisation, has supplied 10 new dental units and chairs for Prizren and Gjakovë/Djakovica; UK's Department for International Development (DFID) provided funds for the repair of equipment in the Dental School, and DHIN of the Netherlands has given instruments and equipment for the School and for seven dental laboratories. The Saudi Joint Relief Committee has provided dental units and other equipment for 10 health houses.
Other equipment and support has come from Caritas Sardinia, the Finnish Red Cross, Medair, COI, Die Johanniter and France Humanitaire.
PHARMACEUTICALS
New staff for procurement office
Three new members of staff have been recruited for the DHSW pharmaceuticals procurement office after interviews of suitable candidates. A pharmacist and a technician in pharmaceuticals started work last week, although contracts are still subject to agreement on salary scales. It is hoped that the third new member of staff, an economist, will be able to start soon.
The increase in staff coincides with a long awaited and very welcome development - the procurement office and the Kosovo Drug Regulatory Authority have at last got keys to new offices. These are located on the 6th floor of the RTK building in Pristina, across Mother Theresa Street from the DHSW headquarters in the Eximkos building. However it is too early to celebrate; the offices have been renovated by UNMIK but are still unfurnished. The pharmaceuticals supply system adviser appointed by WHO to UNMIK, Alain Pierre, is due to complete his contract at the end of this week. However he will return to Kosovo in the middle of next month to carry on with the same work, this time under the auspices of the European Agency for Reconstruction (see Focus page).
2001 drugs supplies up for tender
An open international tender for pharmaceutical supplies for next year is due to be published this week. There are about 600 items on the list. Deadline for bids is 5 December, and analysis of tenders is expected to take between six weeks and two months. This means that the first shipment is unlikely to be before the beginning of March 2001.
Tender documents can be obtained from the Department of Health, either in hard copy or in electronic. Interested parties should apply directly to DHSW deputy co-head Bengt Stalhansdke or to financial assistant Rajesh Kayastha. Written applications forms will also be available.
The tender, N° DHSW/001/2000, is for the Procurement of Pharmaceuticals Drugs, Vaccines, Contraceptives, Haemodialysis products and Consumables for Hospitals and Primary Health Care Facilities.
Storage space of at least 3000 m2 will have to be found before the first shipment for both hospital and PHC drugs arrives in Kosovo.
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Survey on the availability of essential drugs
The results of a survey on the availability of essential drugs in the public health facilities and prices of essential drugs in private pharmacies carried out in June/July 2000 have now been published. The results show a wide variation of the cost of over-the-counter drugs in different parts of Kosovo.
The survey had two main aims: to obtain a picture of the availability of the 25 indicator drugs from the Primary Health Care Essential Drug List in public health facilities – where these drugs are currently distributed to patients free of charge; and, to examine the retail price of the same indicator drugs from private pharmacies – where the patients buy the drugs if the public-funded suppliers are insufficient or the patient does not obtain a drug available in the public facilities. This might be due to the insistence of the prescriber or the patient on branded rather than generic products.
The survey was carried out in state pharmacies, health houses, ambulantas and private pharmacies in 12 municipalities. Seven towns and 24 villages were randomly selected. The survey, a collaboration between the WHO pharmaceuticals project and students of Pristina University Pharmacy Faculty, was carried out twice at an interval of two weeks.
Detailed results are available from the WHO Pharmaceuticals Project, email dardanearifaj@ hotmail.com
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Funding needed to revive Farmakos
A technical review of the Farmakos drug company in Prizren, and an assessment of its compliance with recommendations for improvements made a year ago, were carried out last week.
The quality control laboratory needs additional instruments and equipment to be able to test all products up to required specifications.
Most of the recommendations from last year's report have been carried out, although Farmakos still has to achieve Good Manufacturing Practice (GMP) standards. A comprehensive three-phase investment programme, totaling around 13 million DEM, has been drawn up by the Economic Institute of Pristina and is waiting for investors.
The WHO expert who performed last week's review has recommended that the factory should begin work with the re-packaging of bulk imported drugs. Drug manufacturing could resume in early 2002 if investment funds can be identified.
KFOR SUPPORT
British Army's head nurse visits Kosovo
Talking shop: The UK's Director of Army Nursing, Colonel B.C. McEvilly (right), visited Pristina University Hospital during her trip to Kosovo last month. Fekrije Hasani (centre), head nurse of the University Clinical Centre, joined her on the tour of some of the hospital departments, including a training room which has been developed with assistance from British KFOR.
GENERAL HEALTH MEETING