Governance and management of health care institutions in Serbia: An overview of recent developments

In order to promote awareness of factors that affect social services, their quality, effectiveness and coverage, the term “governance” is frequently used. However, there is no agreement on definitions, frameworks and how it relates to the health sector. In this overview, two interrelated processes in Serbia will be analyzed: governance and management at the macro-, meso-, and micro level. Key messages are as follows: i) Continue decentralization and support to an effective national decision-making body (Health Council of Serbia) with all relevant stakeholders; ii) Reduce the well-known implementation gap and agree on a binding time frame for reforms, and; iii) Establish obligatory schemes for education and training of managers and support sustainability of state institutional capacity to teach, train and advise on a scientific basis

Health and health status of children in Serbia and the desired Millennium Development Goals

Aim: Children represent the future, and ensuring their healthy growth and development should be a prime concern of all societies. Better health for all childrenis one of the leading objectives of the National Plan of Action for Children and a keyelement of the tailored Millennium Development Goals for Serbia. Methods: Our analysis was based on relevant literature and available information from the primary and secondary sources and databases. We analyzed health status of children that can be illustrated by indicators of child and infant mortality, morbidity,and nutritional status. Results: There has been a significant reduction in the mortality rates at the nationallevel, particularly with regard to infants and children under five years of age. However, the current mortality rate of Roma children is still three times as high as the Millennium Goal set at the national level for Serbia. Most deaths of children under theage of five are due to preterm birth complications, congenital anomalies, birthasphyxia and trauma, pneumonia and sepsis. The rate of malnourished childrenamong the poor and in Roma settlements is twice as high as in the general population of Serbian children. A growing number of obese children was also noted in the Roma population. Conclusion: Political awareness, commitment and leadership are required to ensurethat child health receives receive the attention and the resources needed to accelerate the progress of Serbia

Governance and management of health care institutions in Serbia: An overview of recent developments

In order to promote awareness of factors that affect social services, their quality, effectiveness and coverage, the term “governance” is frequently used. However, there is no agreement on definitions, frameworks and how it relates to the health sector.In this overview, two interrelated processes in Serbia will be analyzed: governance and management at the macro-, meso-, and micro level.Key messages are as follows: i) Continue decentralization and support to an effective national decision-making body (Health Council of Serbia) with all relevant stakeholders; ii) Reduce the well-known implementation gap and agree on a binding time frame for reforms, and; iii) Establish obligatory schemes for education and training of managers and support sustainability of state institutional capacity to teach, train and advise on a scientific basis

Piloting an advanced methodology to analyse health care policy networks: The example of Belgrade, Serbia

Aim: Political decisions usually emerge from the competing interests of politicians, voters, and special interest groups. We investigated the applicability of an advanced methodological concept to determine whether certain institutional positions in a cooperating network have influence on the decision-making procedures. To that end, we made use of the institutional network of relevant health care and health governance institutions, concentrated in Belgrade, Serbia. Methods: We used a Principal Component Analysis (PCA) based on a combination of measures for centrality in order to evaluate the positions of 25 players in Belgrade‟s institutional network. Their directed links were determined by a simulated position approach employing the authors‟ long-term involvement. Software packages used consisted of Visone 2.9, UCINET 6, and KeyPlayer 1.44. Results: In our analysis, the network density score in Belgrade was 71%. The PCA revealed two dimensions: control and attractiveness. The Ministry of Health exerted the highest level of control but displayed a low attractiveness in terms of receiving links from important players. The National Health Insurance Fund had less control capacity but a high attractiveness. The National Institute of Public Health‟s position was characterized by a low control capacity and high attractiveness, whereas the National Drug Agency, the National Health Council, and Non-Governmental Organisations were no prominent players. Conclusions: The advanced methodologies used here to analyse the health care policy network in Belgrade provided consistent results indicating that the intended decentralization of the health care network in Belgrade may be incomplete, still with low participation of civil society representatives. With the present study we set the stage for a broad-range survey based data collection applying the methodology piloted in Belgrade

Community Development for Health Promotion

Development of a healthy community today represents an important process from different stand point, especially for improvement of population health and for health promotion intervention among vulnerable population groups such as women and children, adolescents, poor people and refugees. Community orientated approach particularly ensures proper identification and meeting the needs of underserved population groups which are most often not recognised among under, either because they belong to special ethnical or cultural groups or to groups of poor. Community strengthening for improvement of their health is realised through the wide and sustainable partnership of local community members, their leaders, supportive organisations, financers and governmental institutions, which is present in all phases of health promotion intervention. Examples of community based health promotion programmes, in world and in Serbia, show that wide partnership ensures improvement of numerous health determinants which is impossible to achieve by isolated health service activities. Authentic community leaders that are educated for successful leadership during all phases have prominence in development of these programmes. Achievement of their long-term sustainability through the multidisciplinary approach is a constant challenge to community based health promotion programmes

Maternal and new-born health policy indicators for low-resourced countries: The example of Liberia

Aim: Over the past two decades, two catastrophic events caused a steep decline in health services in Liberia: the long-lasting civil war (1989-2003) and the weak response of the health system to the Ebola Viral Disease (EVD) outbreak (2013-2015). In early 2015 The Liberian Government reacted and developed a strategic health policy framework. This paper reviews that framework with a focus on maternal and newborn health. Methods: The study is designed as a narrative review executed during the second half of 2017 in Monrovia. It takes advantage of triangulation, derived from recent international and national documents, relevant literature, and available information from primary and secondary sources and databases. Results: In 2015 the severely compromised health system infrastructure included lack of functional refrigerators, low availability of vaccines and child immunization guidelines, high stock-out rates, and an absence of the cold chain minimum requirements in 46% of health facilities. The public health workforce on payroll during 2014/15 included only 117 physicians. Skilled birth attendance as an indicator of maternal health services performance was 61%. Presently, approximately 4.5 women die each day in Liberia due to complications of pregnancy, delivery, and during the post-partum period, equalling about 1,100 women per 100,000 live births. Of particular note is the adolescent birth rate of 147 per 1000 women aged 15-19 years, three times higher than the world average of 44. Additionally, with a neonatal mortality rate of 19.2 neonatal deaths per 1,000 live births, Liberia stands higher than the world average as well. The high mortality rates are caused by multiple factors, including a delay in recognition of complications and the need for medical care, the time it takes to reach a health facility due to a lack of suitable roads and transportation, and a delay in receiving competent care in the health facilities. Conclusions: The fact that performance is above average for some indicators and far below for other points to unexplained discrepancies and a mismatch of international and national definitions or validity of data. Therefore, it is recommended to concentrate on the core of tracer indicators adopted at the global level for Universal Health Coverage and the Sustainable Development Goals to enable a permanent update of relevant information for policymaking and adjustment. At present all health policy documents miss a thorough application of the SMART objectives (Specific, Measurable, Attainable, Relevant and Timely), notably missing in most documents are realistic and detailed budgeting and obligatory timelines for set targets

Two sides of a broken medal: Disease prevention and health promotion in schools of public health

Aim: Disease prevention and health promotion are closely related through the lifestyle concept and teaching modules on them should be a part of the postgraduate curriculum of every School of Public Health (SPH) in the European Region and beyond. We aimed to determine to which degree the European SPH offer modules on Disease Prevention and Health Promotion in their postgradu-ate programs, but also the delay in full implementation for the target year 2030 that has been set at 100% for all SPHs. Methods: The Association of Schools of Public Health in the European Region (ASPHER) con-ducted two surveys on the activities of its members in 2011 and 2015/16. A group of 48 SPH responded in both surveys. Questions were related to the content offered by SPHs, the types of teaching methods that are in use and presentations of the modules at social networks. Results: For both modules, the 2nd survey in 2015/16 shows slightly less positive results as com-pared to the 1st Survey in 2011 (72.9% vs. 77.1% and 81.3% v. 87.5%). The only exception is the use of social media which increased for disease prevention from 20.8% to 37.5% of all SPH and for health promotion from 22.9% to 39.6%. Referring to the set target of 100%, delays between 4 and 13.5 years accumulate for the target year 2030.Conclusion: With the exception of the use of social media, progress towards 2030 is slow or even negative. Serious efforts have to be made by ASPHER to revert this process. Acknowledgments: The authors would like to thank all members of ASPHER for their commit-ment in responding to the survey questionnaire and providing examples of good practices in edu-cation, training and research for public health. Conflict of interest: None declared

Delays in Achieving Maternal, Newborn, and Child Health Targets for 2021 and 2030 in Liberia

Laaser U, Broniatowski R, Byepu S, Bjegovic-Mikanovic V. Delays in Achieving Maternal, Newborn, and Child Health Targets for 2021 and 2030 in Liberia. Frontiers in Public Health. 2019;7: 386.Objectives: The Government of Liberia has set ambitious national health targets for 2021 to reduce the high maternal, newborn, and child mortality rate and to improve the related health services. Additionally, Sustainable Development Goal 3 provides a long-term target for 2030. The objective of this article is to analyze the gaps between the targets and collected data. Materials and Methods: Relevant national documents were scrutinized to identify targets and related indicators which can serve as benchmarks for future achievements in Liberia's maternal, newborn, and child health. For each indicator, progress observed will be compared with that needed to meet the target, based on the indicator value in a baseline year, a later observed value, and the expected value in 2021 and 2030, respectively. Results: The Gap Analysis reveals achievements and serious delays for 21 health and health system indicators. Based on national data the reduction of the maternal mortality ratio will take an additional -8.2 years for the 2021 target and -12.5 years for the 2030 target. The Neonatal Mortality rate is experiencing similar delays of -7.9 years for 2021 and -12.9 for 2030 whereas the targets for the Under-5-Mortality rate can be achieved with small delays of -1.8 and -1.7 years. Conclusions: The Government of Liberia requires persistent efforts and international support to achieve its national targets and the Sustainable Development Goal 3 for health