Izvješće o stanju i razvoju hrvatskog zdravstvenog sustava od 1990. do 1995. godine (The Report on the Condition and Development of Croatian Health System from 1990 to 1995)

 UVOD                   Ministarstvo zdravstva republike Hrvatske u suradnji sa Hrvatskim zavodom za javno zdravstvo izradilo je 1996. godine, za potrebe Zastupničkog doma Sabora RH, Izvješće o stanju i razvoju hrvatskog zdravstvenog sustava tijekom Domovinskog rata. Poradi ekstenzivnosti izvješće je djelomično skraćeno.                   1.  NASLIJEčENI ZDRAVSTVENI SUSTAV                   Nakon prvih demokratskih izbora preuzeli smo organizaciju zdravstvenog sustava koja je bila karakteristična za samoupravni socijalizam. Negativne strane tog sustava bile su nedefinirano vlasništvo i upravljanje, nedostatak financijskog stručnog nadzora, nekontrolirani i potpuno raspršeni sustav financiranja bez financijskih normativa i kontrole, te potpuni nedostatak cjelokupnog programa usklađenog prema broju stanovnika i nacionalnog dohotka. Pozitivna strana naslijeđenog sustava bila je vrlo dobar stručni kadar, školovan na domaćim ali većim djelom i na stranim učilištima. Naslijeđen je i kvalitetan sestrinski kadar kao i dobro uhodane medicinske škole sa suvremenim nastavnim programima.                   Naslijeđena infrastruktura nalazi se u nedopustivo lošem stanju, daleko ispod razine nacionalnog dohotka. Komfor u naslijeđenim bolničkim kapacitetima te ordinacijama primarne zdravstvene zaštite u većini slučajeva je na razini tri do četiri puta niži od europske a preko polovina ukupnih kapaciteta ne zadovoljava uobičajene zdravstvene niti sanitarne normative. Naslijeđena oprema je zapuštena i zastarjela tako da je otpisana ukupno s preko 80% ukupne vrijednosti.                   Opisano stanje uzrokovalo je zdravstvene pokazatelje koje su bili značajno lošiji nego u zapadnuropskim zemljama ali u većini zdravstvenih područja bolji nego u drugim komunističkim zemljama. Ovo se osobito odnosi na prevenciju zaraznih bolesti. Sustav je karakterizirao potpuni nedostatak zdravstvenog prosvjećivanja, a zdravstveni pokazatelji bili su loše prikupljeni i nisu služili kao baza za organizacijske promjene

Izvješće o stanju i razvoju hrvatskog zdravstvenog sustava od 1990. do 1995. godine (The Report on the Condition and Development of Croatian Health System from 1990 to 1995)

 UVOD                   Ministarstvo zdravstva republike Hrvatske u suradnji sa Hrvatskim zavodom za javno zdravstvo izradilo je 1996. godine, za potrebe Zastupničkog doma Sabora RH, Izvješće o stanju i razvoju hrvatskog zdravstvenog sustava tijekom Domovinskog rata. Poradi ekstenzivnosti izvješće je djelomično skraćeno.                   1.  NASLIJEčENI ZDRAVSTVENI SUSTAV                   Nakon prvih demokratskih izbora preuzeli smo organizaciju zdravstvenog sustava koja je bila karakteristična za samoupravni socijalizam. Negativne strane tog sustava bile su nedefinirano vlasništvo i upravljanje, nedostatak financijskog stručnog nadzora, nekontrolirani i potpuno raspršeni sustav financiranja bez financijskih normativa i kontrole, te potpuni nedostatak cjelokupnog programa usklađenog prema broju stanovnika i nacionalnog dohotka. Pozitivna strana naslijeđenog sustava bila je vrlo dobar stručni kadar, školovan na domaćim ali većim djelom i na stranim učilištima. Naslijeđen je i kvalitetan sestrinski kadar kao i dobro uhodane medicinske škole sa suvremenim nastavnim programima.                   Naslijeđena infrastruktura nalazi se u nedopustivo lošem stanju, daleko ispod razine nacionalnog dohotka. Komfor u naslijeđenim bolničkim kapacitetima te ordinacijama primarne zdravstvene zaštite u većini slučajeva je na razini tri do četiri puta niži od europske a preko polovina ukupnih kapaciteta ne zadovoljava uobičajene zdravstvene niti sanitarne normative. Naslijeđena oprema je zapuštena i zastarjela tako da je otpisana ukupno s preko 80% ukupne vrijednosti.                   Opisano stanje uzrokovalo je zdravstvene pokazatelje koje su bili značajno lošiji nego u zapadnuropskim zemljama ali u većini zdravstvenih područja bolji nego u drugim komunističkim zemljama. Ovo se osobito odnosi na prevenciju zaraznih bolesti. Sustav je karakterizirao potpuni nedostatak zdravstvenog prosvjećivanja, a zdravstveni pokazatelji bili su loše prikupljeni i nisu služili kao baza za organizacijske promjene

Transformation of Health Services from Civilian to Wartime Medical Corps – Example from Bosnia and Herzegovina

In the multiethnic Bosnia and Herzegovina, Croats and Muslims, attacked by the Yugoslav army and Serbs, had to employ rationally their poorly provisioned civilian health services so that they could respond to the extremely numerous and prompt needs of war conditions. The health services in the areas controlled by Croats and Muslims had to be reorganized twice because of sudden changes of wartime conditions.With further development of the situation, when all three sides participated in the conflict, the number of wounded increased rapidly. In the meantime, a large-scale population shift on an ethnic basis occurred in all parts of Bosnia and Herzegovina, thus giving rise, along with a greater number of the wounded, to a severe humanitarian crisis. Civilians were therefore another heavy burden to the wartime health services. This created enormous problems for the inadequately provisioned health services of Bosnia and Herzegovina in the area under the control of Croats and Muslims. However, poorly equipped with personnel as well as everything else, the health services in the area controlled by Croats and Muslims, through appropriate reorganization, successfully accomplished their task in the wartime medical corps. Besides this correctly executed transformation from civilian health services into a wartime medical corps, high motivation of medical staff also greatly contributed to successful operation of the medical corps in the war zone despite the long duration of the war. In the majority of cases, the wounded were within 30–40 minutes from the moment of injury in the hands of a surgical team and within the next ten minutes were already in the operating theater. After primary wound dressing, the wounded were sent to one of the well-organized main war hospitals for further treatment. This resulted, along with secure evacuation routes, in a minimum number of lifelong invalidity among the wounded

A Large Cross-Sectional Study of Health Attitudes, Knowledge, Behaviour and Risks in the Post-War Croatian Population (The First Croatian Health Project*)

As the liberation of occupied Croatian territories ended the war in the country in 1995, the Ministry of Health and Croatian Health Insurance Institute have agreed to create the new framework for developing a long-term strategy of public health planning, prevention and intervention. They provided financial resources to develop the First Cro-atian Health Project, the rest of the support coming from the World Bank loan and the National Institute of Public Health. A large cross-sectional study was designed aiming to assess health attitudes, knowledge, behaviour and risks in the post-war Croatian population. The large field study was carried out by the Institute for Anthropological Research with technical support from the National Institute of Public Health. The field study was completed between 1995–1997. It included about 10,000 adult volunteers from all 21 Croatian counties. The geographic distribution of the sample covered both coastal and continental areas of Croatia and included rural and urban environments. The specific measurements included antropometry (body mass index and blood pressure). From each examinee a blood sample was collected from which the levels of total plasma cholesterol (TC), triglycerides (TG), HDL-cholesterol (High Density Lipoprotein), LDL-cholesterol (Low Density Lipoprotein), lipoprotein Lp(a), and haemostatic risk factor fibrinogen (F) were determined. The detailed data were collected on the general knowledge and attitudes on health issues, followed by specific investigation of smoking history, alcohol consumption, nutrition habits, physical activity, family history of chronic non-communicable diseases and occupational exposures. From the initial database a targeted sample of 5,840 persons of both sexes, aged 18–65, was created corresponding by age, sex and geographic distribution to the general Croatian population. This paper summarises and discusses the main findings of the project within this representative sample of Croatian population

The breadth of primary care: a systematic literature review of its core dimensions

Background: Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods: A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results: Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions: A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health

Family medicine in post-communist Europe needs a boost. Exploring the position of family medicine in healthcare systems of Central and Eastern Europe and Russia

<p>Abstract</p> <p>Background</p> <p>The countries of Central and Eastern Europe have experienced a lot of changes at the end of the 20th century, including changes in the health care systems and especially in primary care. The aim of this paper is to systematically assess the position of family medicine in these countries, using the same methodology within all the countries.</p> <p>Methods</p> <p>A key informants survey in 11 Central and Eastern European countries and Russia using a questionnaire developed on the basis of systematic literature review.</p> <p>Results</p> <p>Formally, family medicine is accepted as a specialty in all the countries, although the levels of its implementation vary across the countries and the differences are important. In most countries, solo practice is the most predominant organisational form of family medicine. Family medicine is just one of many medical specialties (e.g. paediatrics and gynaecology) in primary health care. Full introduction of family medicine was successful only in Estonia.</p> <p>Conclusions</p> <p>Some of the unification of the systems may have been the result of the EU request for adequate training that has pushed the policies towards higher standards of training for family medicine. The initial enthusiasm of implementing family medicine has decreased because there was no initiative that would support this movement. Internal and external stimuli might be needed to continue transition process.</p