Experiences from integrating water and sanitation safety planning in small systems in rural Serbia.

The WHO recommends a risk management approach to ensure safe drinking-water and sanitation, so-called Water Safety Planning and Sanitation Safety Planning. However, applying these risk management approaches separately in small-scale drinking-water supply and sanitation systems might be challenging for rural communities with limited human, financial, and administrative resources. An integrated approach seems a better option. In this study, an integrated water and sanitation safety planning (iWSSP) approach was developed together with guidance and training material for the practical application of this novel approach. The integrated approach was piloted in three small systems in rural Serbia to identify benefits and suggestions for improvement which can be used for potential future scaling-up. Implementing iWSSP at the pilot sites contributed to a better understanding of both drinking-water supply and sanitation systems. It also resulted in increased awareness, knowledge, and understanding among staff of drinking-water supply and sanitation services. Key experts, including external facilitators, played a crucial role in the implementation of iWSSP. Future scaling-up of the integrated approach could be enabled if more guidance, easy-to-use training materials and templates become available which can be adapted and updated as needed.

Monitoring Health Inequalities in 12 European Countries: Lessons Learned from the Joint Action Health Equity Europe.

To raise awareness about health inequalities, a well-functioning health inequality monitoring system (HIMS) is crucial. Drawing on work conducted under the Joint Action Health Equity Europe, the aim of this paper is to illustrate the strengths and weaknesses in current health inequality monitoring based on lessons learned from 12 European countries and to discuss what can be done to strengthen their capacities. Fifty-five statements were used to collect information about the status of the capacities at different steps of the monitoring process. The results indicate that the preconditions for monitoring vary greatly between countries. The availability and quality of data are generally regarded as strong, as is the ability to disaggregate data by age and gender. Regarded as poorer is the ability to disaggregate data by socioeconomic factors, such as education and income, or by other measures of social position, such as ethnicity. Few countries have a proper health inequality monitoring strategy in place and, where in place, it is often regarded as poorly up to date with policymakers' needs. These findings suggest that non-data-related issues might be overlooked aspects of health inequality monitoring. Structures for stakeholder involvement and communication that attracts attention from policymakers are examples of aspects that deserve more effort.

Towards equal access to health services in Serbia

Serbia has a comprehensive universal health system withfree access to health care, but there are inequities in the utilisation of health services. Some vulnerable groups, such as those living in poverty or Roma people in settlements, have more barriers in accessing health care. Financial constraints are the main reason for unmet needs, in particular for the less educated and the poorest. Although citizens are generally satisfied with public and private health care services, a significant number of patients are on waiting lists. Therefore, reaching equal access to health services should be one of the leading health policy goals.

Serbia: Health System Review.

This analysis of the Serbian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the Serbian population has improved over the last decade. Life expectancy at birth increased slightly in recent years, but it remains, for example, around 5 years below the average across European Union countries. Some favourable trends have been observed in health status and morbidity rates, including a decrease in the incidence of tuberculosis, but population ageing means that chronic conditions and long-standing disability are increasing. The state exercises a strong governance role in Serbia's social health insurance system. Recent efforts have increased centralization by transferring ownership of buildings and equipment to the national level. The health insurance system provides coverage for almost the entire population (98%). Even though the system is comprehensive and universal, with free access to publicly provided health services, there are inequities in access to primary care and certain population groups (such as the most socially and economically disadvantaged, the uninsured, and the Roma) often experience problems in accessing care. The uneven distribution of health professionals across the country and shortages in some specialities also exacerbate accessibility problems. High out-of-pocket payments, amounting to over 40% of total expenditure on health, contribute to relatively high levels of self-reported unmet need for medical care. Health care provision is characterized by the role of the "chosen doctor" in primary health care centres, who acts as a gatekeeper in the system. Recent public health efforts have focused on improving access to preventive health services, in particular, for vulnerable groups. Health system reforms since 2012 have focused on improving infrastructure and technology, and on implementing an integrated health information system. However, the country lacks a transparent and comprehensive system for assessing the benefits of health care investments and determining how to pay for them.

Serbia: health system review

This analysis of the Serbian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the Serbian population has improved over the last decade. Life expectancy at birth increased slightly in recent years, but it remains, for example, around 5 years below the average across European Union countries. Some favourable trends have been observed in health status and morbidity rates, including a decrease in the incidence of tuberculosis, but population ageing means that chronic conditions and long-standing disabilityare increasing. The state exercises a strong governance role in Serbia’s social healthinsurance system. Recent efforts have increased centralization by transferring ownership of buildings and equipment to the national level. The health insurance system provides coverage for almost the entire population (98%). Even though the system is comprehensive and universal, with free access to publicly provided health services, there are inequities in access to primary careand certain population groups (such as the most socially and economically disadvantaged, the uninsured, and the Roma) often experience problems in accessing care. The uneven distribution of health professionals across the country and shortages in some specialities also exacerbate accessibility problems. High out-of-pocket payments, amounting to over 40% of totalexpenditure on health, contribute to relatively high levels of self-reported unmet need for medical care. Health care provision is characterized by the role of the “chosen doctor” in primary health care centres, who acts as a gatekeeper in the system. Recent public health efforts have focused on improving access to preventive health services, in particular, for vulnerable groups. Health system reforms since 2012 have focused on improving infrastructure and technology, and on implementing an integrated health information system. However, the country lacks a transparent and comprehensive system for assessing the benefits of health care investments and determining how to pay for them.

Strengthening the public health workforce: An estimation of the long-term requirements for public health specialists in Serbia.

At the beginning of the 21st century, planning the public health workforce requirements came into the focus of policy makers. The need for improved provision of essential public health services, driven by a challenging non-communicable disease and causes of death and disability within Serbia, calls for a much needed estimation of the requirements of the public health professionals. Mid and long-term public health specialists' supply and demand estimations out to 2025were developed based on national staffing standards and regional distribution of the workforce in public health institutes of Serbia. By 2025, the supply of specialists, taking into account attrition rate of -1% reaches the staffing standard. However, a slight increase in attrition rates has the impact of revealing supply shortage risks. Demand side projections show that public health institutes require an annual input of 10 specialists or 2.1% annual growth rate in order for the four public health fields to achieve a headcount of 487 by 2025 as well as counteract workforce attrition rates. Shortage and poor distribution of public health specialists underline the urgent need for workforce recruitment and retention in public health institutes in order to ensure the coordination, management, surveillance and provision of essential public health services over the next decade.

Better noncommunicable disease outcomes: challenges and opportunities for health systems: Serbia country assessment

Despite positive trends, life expectancy in Serbia is well below the average for the WHO European Region.The probability of dying from one of the main noncommunicable diseases (NCDs) between the ages of30 and 69 years is 20%. This has significant socioeconomic consequences for the development of thecountry and calls for an immediate strengthening of the health system to respond to the growing burdenof NCDs. Despite significant progress and political commitment in Serbia, the outcomes of NCDs couldstill be improved. This report reviews the challenges and opportunities facing the health system in Serbiain scaling up core services for the prevention, early diagnosis and management of NCDs. The report alsoprovides examples of good practice in care. Policy recommendations are made for further action, based onthe assessment.

Mapping the governance of human resources for health in Serbia.

This article maps the current governance of human resources for health (HRH) in relation to universal health coverage in Serbia since the health sector reforms in 2003. The study adapts the Global Health Workforce Alliance/World Health Organization four-dimensional framework of HRH in the context of governance for universal health coverage. A set of proxies was established for the availability, accessibility, acceptability and quality of HRH. Analysis of official HRH documentation from relevant institutions and reports were used to construct a governance profile of HRH for Serbia from the introduction of the reform in 2003 up to 2013. The results show that all Serbian districts (except Sremski) surpass the availability threshold of 59.4 skilled midwives, nurses and physicians per 10,000 inhabitants. District accessibility of health workforce greatly differed from the national average with variances from +26% to -34%. Analysis of national averages and patient load of general practitioners showed variances among districts by ± 21%, whilst hospital discharges per 100 inhabitants deviated between +52% and -45%. Pre-service and in-service education of health workforce is regulated and accredited. However, through its efforts to respond to population health needs Serbia lacks a single coordinating entity to take overall responsibility for effective and coordinated HRH planning, management and development within the broader landscape of health strategy development.

Ten years development of human resources in Serbian health system.

A key component of any healthcare reform process is to ensure that the services are delivered by the right numbers of staff with appropriate skills and training. In 2007, public health institutions in Serbia had 2% more employees than before the economic transition. Nevertheless, the trend of the total number of employees in the Serbian health care system still preserved a mild rising trend. The most prominent changes in the structure of human resources were effectuated in the total numbers of physicians, nurses and administrative and technical staff. Development of medical science and practice in Serbia is characterized by more intensive processes of specializations, resulting in increased number of specialists among medical doctors. Health care provided in in-patient institutions still employs most of the doctors. The number of unemployed physicians, dentists and pharmacists has been rising since 2000. Another aspect that explains the rise of unemployed, university educated human resources is the rising number of graduated physicians, dentist and pharmacists. Health care policy makers may recognize the need for more integrated planning of human resources in health care, in particular, making management of human resources responsive to system needs and design, instead of vice versa.

Health care managers as a crucial component of health care workforce in Serbia.

The aim of the paper was to describe and analyse health services management in Serbia, commencing with present status and projecting, as accurately as possible, future changes over the next years, skills and required competencies of the health management workforce. The study was done as a part of Ministry of Health/EU funded Project "Preparation for Health Management Training Programme in Serbia" by a desk review of current and draft legislation, related projects in the health sector and relevant local and international literature; semi-structured interviews with key local and international stakeholders and a structural analysis of the health management sector. The results of the study have shown that there was a big gap in knowledge and skills regarding Health Management in Serbia and a true need for such type of education.