Health Policy



Report on Activities of

World Health Organization

Kosovo

October- December 2000

TABLE OF CONTENTS

I. MANAGEMENT 3

II. OPERATIONS 3

Health service delivery 3

Primary Health Care 3

Health Policy 7

Hospitals 9

Pharmaceutical 10

Mother and Child Health 11

Mental Health 13

Environmental health and public health service 15

Institute of Public Health 15

Environmental Health 17

Regional Public Health Advisors 20

Field Office for Pristina, Gjilan 20

Field Office for Gjakova, Peja and Prizren 21

Field Office for Mitrovica 22

III. ADMINISTRATION 23

Administration and Finance 23

Information Technology 23

Logistics Support 24

I. MANAGEMENT

Staff

Dr Erik Schouten, Head of Mission

Elisabeth Asirifi, Policy adviser to head of office (from 19.12.00)

Natyra Bajrami Personal assistant to the head of office

In October a management team was installed consisting of all heads of unit

including the administrator, logistics and information officer. The

management team meets every week and all relevant issues are discussed.

The WHO Kosovo part of the CAP for the Balkans was developed after a big

group (20) of the office followed a two-day training course in the logical

framework. The CAP was focussing on themes, such as 'health service

delivery' and 'health of young people' in stead of programmes of the

different issues. The development of the CAP was a starting point to improve

co-operation between the different units in the WHO office. In December all

major donors were invited for a two-day study tour to visit the different

WHO programmes and to meet and discuss with WHO staff. Since December

Elisabeth Asirifi strengthens the management of the office by providing

policy advice to the head of office and support in the management of the WHO

programmes in Kosovo.

II. OPERATIONS

Health service delivery

Primary Health Care

Staff

Sue Woodward, PHC Co-ordinator

Dr Paula Silverman, Family Medicine Programme Manager (until December)

Dr Robert Hedley, Family Medicine Programme Co-ordinator (until December)

Dr Robert McGibbon, International Field Teacher

Dr Rose Ansorge, International Field Teacher

Dr Attila Simay, International Field Teacher

Dr Isah Rustemi, International Field Teacher

Kamile Ozcan, Clinical Supervisor

Afërdita Ademi, Site Manager

Dr Jashar Ramadani, Site manager

Dr Jetan Vorfi, Site manager

Dr Selvi Kutllovci, Regional NPO

Bajram Maxhuni, NPO

Genc Buçinca, NPO

Genc Halili, NPO

Dafina Gexha, Secretary/Finance Clerk

Arbëresha Turjaka, Translator

Dr Valbana Vracica, Translator

Burim Hadri, Translator

Transfer of Responsibilities to Municipalities

The municipality leaders, together with the Family Medicine team, the DHSW, the EU country planner and WHO, meet in Gjakova to discuss issues regarding the transfer of responsibilities to the municipalities. Gjakova Municipality is considered to be leading the field in family medicine infrastructure development. A focus group was established to develop a template across primary care, which will assist municipality boards on the minimum resource requirements to enable planning for comprehensive but affordable health care service in the community for the future. The meeting was an excellent example of collaborative work and it was agreed that a WHO member would chair the next two meetings, while a local municipality leader shall chair the subsequent meetings. A draft specification or service contract to support the devolved power to municipalities will be developed.

Family Medicine

The first management steering group for the future family medicine programme in Kosovo was attended by WHO, the Department of Health and Social Welfare (DHSW or the Department) and the Pristina University Medical faculty. A smooth handing over of training programs to the Kosovo representatives upon the completion of international funding was discussed. Dr Robert Stevens, European Agency for Reconstruction (EAR), was elected to drive the process and chair the meetings.

Meetings have been held with internists, paediatricians and obstetricians-gynaecologists working in primary care in all municipalities to provide an update to primary care specialists on developments in family medicine and to elicit their opinions on specialist CPD. The results from the group discussions and surveys with specialists in 17 Health Houses have been analysed and a paper has been written. Despite some concerns, specialists support the family medicine concept, the gatekeeper role and would welcome an opportunity for their own CPD.

Regional sector heads are continuing the process of developing new training centres in Peje, Prizren, Mitrovice, Lipjan and Ferizaj. The training plan for the CPD course in 2001 has been developed.

Primary care co-ordination meeting

In response to the Department ‘s request, the primary care planning group is assisting in the identification of diagnostic needs at municipality level. A municipality wide questionnaire survey of equipment and usage is being conducted with the assistance of Regional Public Health Advisors and Pharmaciens Sans Frontieres (PSF). The report was submitted to the Department and was approved with slight amendments. ECHO agreed to purchase 1 million EU of primary care equipment including simple x-ray equipment for 11 Standard Family Health centres. WHO was commented on the work both in office and in the field.

Capacity building and training support

The Helsinki Consulting group initiated a meeting with WHO and NGOs to engage support for the planned capacity training of nurses in the field. Local nurse leaders in secondary sector were invited to the meeting. WHO presented its work to date on training in Kosovo and the organisation was recognised as a key to the programme’s success with its model being accepted as the way forward.

IMC, Save the Children, Finnish Red Cross, German Red Cross, Cordaid and Caritas showed interest in training the required number of nurses (1500) in the various geographical areas.

WHO attended and presented the primary model and the family medicine programme at the nursing workshop, which was attended by the Department of Health, Dept of Education, the EU and various NGOs. To gain immediate support, the Departments of Health and Education agreed on the priority branches: family nurse training to support the family doctors, mental health nursing to support the community mental health strategy and midwifery to address the priority of MCH.

At a separate meeting between WHO and the Helsinki Group, the Group’s decision to target 3 million German Marks into primary care over the next three years was discussed. Part of the funding will go towards the support of primary care training for the required 1500 nurses and part will be allocated to family nurse CPD training in the community. WHO has agreed to act as technical advisor to the group and to establish a programme by January 2001, starting with the first cohort of Trainer of the Trainer (ToT) nurses. At the request of ECHO, a draft concept paper was written by WHO programme co-ordinator and shared with key people. In the Helsinki proposal, which was circulated and presented to the Finish Ministry of Health, the primary nurse programme is to follow the WHO family doctor model.

A WHO national staff will work with local doctors to produce a simple Kosovo family medicine teaching aids pack, which will assist the new local trainers in the teaching session planned for next year.

Funding the establishment of a nurse association is an urgent priority to drive change. A discussion with a member of the Canadian Public Health Association lead to the review of the secondary and tertiary sector nurse training needs. Further discussions are expected on nurse teacher training and the nurse education curricula. The objective is to raise the required nurse education in Kosovo to the European standards.

Emergency training needs across Kosovo were discussed at a meeting with John Hopkins University, involved at the present in training doctors at the Pristina emergency centre. Under discussion is the possibility of creating a partnership that would provide access to their expertise when the family medicine programme starts common emergency training for its doctors. Agreement was reached to meet at a later time to discuss plans and availability of donor support in order to meet the required needs for the Kosovo doctors and nurses in CPR procedure

The Kosovo LEMON Group continues to be active in co-ordinating training through workshops. Fifteen community and hospital nurses and midwives from Pristina, Prizren, Gjilan, Mitrovica, Shtime and Kamenica attended a workshop in Prizren. It was evident that the participants at the fourth, and possibly the last LEMON Workshop for Albanian speaking nurses organised in Kosovo, are much better informed on various issues such as management of patients with HIV/AIDS, than were those involved in the February Workshop.

Ten nurses attended a 3 day LEMON Group meeting with the nurse consultant to further develop their training skills. Considerable progress has been achieved in providing learning resources and developing a network and leadership amongst Albanian-speaking nurses. There is now a network of 73 nurses covering the whole of Kosovo. It was recommended that Serbian nurses in Kosovo should be included in the LEMON Project as soon as possible. Complete printed copies of the LEMON package in Albanian are expected to be distributed in January 2001.

Education of primary health care nurses who can work in the new family health care centres with doctors recently educated in family medicine is now being addressed at a Regional level.

Discussions continue regarding the pending transfer of EU funds. To ensure minimum disruption to the programme, planned to finish in June 2001, a 2- month extension was requested from ECHO. One-month funding was granted.

Reproductive health module of the CPD course

A partnership between WHO and UNFPA was established on reproductive health training for which the 3rd family medicine module materials have been approved. The reproductive health module adapted for family medicine was utilised for doctors and midwives in training. The curriculum included reproductive health rights, antenatal care, complications of delivery, intra-partum and postpartum care, family planning, reproductive tract infections, gynaecologic care, adolescent care and domestic violence.

The nurse-training agenda and the immediate need of training for midwives and doctors in both antenatal and family planning were discussed between UNFPA, WHO and other NGOs. It was agreed to utilise the relevant section of the WHO family medicine doctors programme curricula relating to reproductive health. A short-term training organised to meet urgent needs would not target doctors and nurses currently selected to participate in the family doctor or nurse training. WHO program co-ordinator will provide technical support to the developing nursing programme for primary care as well as access to the FM curricula on this subject area.

Royal College of General Practitioners

The clinical supervisors have formed a working group to address the recommendations made by the RCGP regarding specific educational aspects of the course such as objectives and assessment procedures that will be incorporated into the preparation of the Common Illness and Emergency Modules. The RCGP is sending 2 members of its International Committee to evaluate the CPD course for accreditation purposes. The final decision on accreditation is pending another visit in the upcoming months due to 3 modules not yet being completed.

Pharmaciens Sans Frontieres

WHO and PSF discussed laboratory training and a survey to be completed in primary care. It was agreed to link PSF into the wider issue of diagnostics and laboratories through the WHO primary care co-ordinating group chaired by the PHC Co-ordinator.

Minority Issues

Minority training for the family doctors programme was discussed with Dr Mateja Kozuh Novak. A suggestion for PHC co-ordinator to prepare a short overview introducing the programme and a proposal to visit both north and south Mitrovica to address the regional meetings at the end of the month followed. The issue of minority training was discussed at a briefing session with Jan Theunissen during his recent visit to Pristina.

Gender Issues

WHO Office participated at meeting on gender issues at the government building. In the run up to the local elections this is seen as an important issue and is expected to remain so in Kosovo. At the first meeting, violence and reproductive health agenda were two topics raised by WHO. The group is to target three particular issues for attention and action, which will be violence, women’s health, and human rights issues. The meeting was reported back to the WHO management group and it was agreed to continue attending these meetings.

Mental Health

Considerable work has been done in co-operation with Dr. Liliana Urbina for the preparation of the Mental Health Module. The concept of community mental health and team approach to patient care will be introduced over the next two months.

Health Policy

Staffing

Dr Dean Shuey, International Health Policy Advisor

Dr Fatime Arenliu Quosaj, NPO

Dr Stephen Briscoe, Human Resource Advisor

Dr Binishi, EMS Consultant

Dr. Walter Mautch, Oral Health Consultant

Professor Jorma Rantanen, Occupational Health Consultant

Draft Health Policy Document

Two hundred people attended a Policy Conference organised on 15 November 2000 at the Grand Hotel. The members of the policy and planning working groups presented suggestions, which were compiled into a matrix format of a draft policy document and then presented to the DHSW. The Heads of Units met to discuss the draft policy paper received back from the Department. Numerous comments received from the field offices were compiled into the final draft document, which was available in Albanian, English and Serbian. The Department agreed to cover the printing costs of the draft paper.

The Gjakova Municipality Planning Group Meeting and the DHSW Planning Municipality Meeting discussed the priorities in policy Implementation Issues.

The Policy Unit will continue following up on the emergency services officer activities with DHSW. Policy meetings continue with Serbian health professionals.

Gender Affairs

WHO was asked to provide comments and suggestions on Kosovo Action Plan for Advancement of Women for the Years 2001-2003 sent by UNMIK Office for Gender Affairs working closely on this issue with the Kosovar Women’s Organisation.

Occupational Health

Discussion meeting took place on the time schedule of the stakeholders as well as regarding visits to main Health Institutions in order to achieve objectives set in the Terms of Reference (TOR) on Occupational Health. The organisation of the Occupational Health in Kosovo, training programs and curricula were discussed at a meeting between the Department and WHO. The occupational consultant’s recommendations need to be followed up. Professors of the Occupational Health Cathedra met to discuss and provide suggestions for future development of the Occupational Health Sector in Kosovo planned to be included in a final report.

Oral Health

Equipment assessment reports are being prepared in Oral Health to define needs and priorities in dental health facilities and to provide recommendations to the DHSW on actions to be taken.

Emergency Services

On the request of Drs Vuori and Kouchner a report was prepared for co-directors meeting on emergency services.

Family Medicine Nursing Program

The Policy unit participates at discussions on Family Medicine Nursing Programme with the Helsinki Group and gave a number of presentations to the Programme attendants on Health Policy, the Health Policy Process and the Health Policy in Kosovo.

Donor Co-ordination Meeting

The Health Policy Officer continues to regularly meet with donors present in Kosovo at the Donor Co-ordination Meetings organised by the Department of Reconstruction.

Hospitals

Staffing

Dr Finn Damgaar Pedersen, Hospital Co-ordinator (September till December 2000).

Dr Arta Ibrani, National Professional Officer

DHSW

The Hospital unit continues to meet regularly with the Department. The current assessment of the situation in Hospitals has been discussed and decision was taken to prepare a list of most important items for presentation at the upcoming meeting in December 2000.

Medevac Committee

The Medevac Committee, consisting of a representative of DHSW hospital officer, IOM and WHO, continues to meet on a weekly basis to make weekly selection of cases for evacuation of patients not able to be treated in Kosovo.

Referral System

Based on the recommendations of the WHO regional health advisors, a referral committee was established to make a proposal of diagnoses and procedures for referral of patients from primary health care level to secondary health care level.

Meetings with Hospital Directors

The hospital unit continues to organise and run weekly hospital directors meetings. Due to the importance of the issues discussed and fundamental decisions to be implemented in the nearest future, it is being suggested that DHSW takes over the full responsibility for co-ordination and development of the hospital sector, to include Pristina University Hospital.

The invitation of the Pristina University Hospital Director to attend the regular meetings has as of yet been unsuccessful and WHO will continue working on this matter.

Medical Equipment

Discussions commenced with hospital directors regarding a European Agency for Reconstruction (EAR) proposed equipment list, the referral system between primary/secondary, as well as the secondary and tertiary level with collaboration of DHSW. Equipment list is still under discussion.

The hospital units plans to continue providing recommendations to EAR regarding medical equipment in regional hospitals and to continue meeting with hospital directors on kind of data and administrative admission to use in the future.

A meeting with Mr Rob Stevens, EAR, took place on the published document “Feasibility study….” Which includes a list of recommendation of equipment to regional hospitals. On the basis of that list we have discussed with the hospital directors and Mr Stevens the possibilities of EAR providing medical equipment. EAR will launch a bid in February 2001 of about 500 000 EURO.

Hospital visits

The Unit continues to visit hospitals and continue discussions with them on the latest developments and issues.

Oncology

Consideration is being given to review and update the current available information on the situation in Oncology services, as they are not mentioned in the blue book. The Hospital unit is planning to write a proposal in order to ensure that Oncology services will not be left out of the health policy document.

Various meetings

In November the unit met with Dr Arne Kverneland, from the Department of Health in Copenhagen, Denmark regarding the development of standardised medical formularies and quality insurance programme in the health sector.

The hospital staff met with ICRC on plans for rehabilitation of Mitrovica hospital and on winterization issues such as heating, windows, water and sanitation.

A meeting with the French Red Cross was organised to raise the issues of the planned project on minorities in Kosovo and their plans to build a new hospital in Gracanica. Considering the secondary care for minority’s situation, the WHO suggested the funds could be used effectively at the Mitrovica hospital.

Pharmaceutical

Staff

Martin Auton, Pharmaceutical Adviser (until December)

Allain Pierre, Pharmaceutical Adviser (until October)

Adnan Mustafa, Hospital Pharmacist

Dardane Arifaj, Pharmaceutical Assistant

Lirim Azizi, Pharmaceutical Assistant

Koloreto Cukali, Pharmaceutical Assistant/Translator

Drug supply system

WHO continues to organise monthly hospital pharmacies’ co-ordination meetings. Regional health co-ordination meetings in Prizren and General Health co-ordination meetings in Pristina are regularly attended by the Unit. Additionally, the unit participates at BI-weekly meetings on Primary Health Care due to the supply of drugs being one of the primary issues in PHC. The unit contributes through the project implementation committee for PHC. Some of the focus of the Unit’s work has shifted to areas in rational drug use. The work on drug regulation and supply was stopped by WHO and has been continued by the EAR Project.

WHO continues to support KFK through facilitation of links between DHSW, ECHO, EU and PSF. The Kosova Pharmaceutical Cooperation (KFK) remains one of the main focuses in the upcoming period and the unit facilitated several meetings in order to provide support to KFK. The expected cessation of activities and programs by Pharmaciens Sans Frontieres in Kosovo was a concern addressed at the co-ordination meeting in order to ensure a smooth hand over of the distribution of drugs to KFK.

WHO is a member of the UNMIK task force on drugs and medical supplies. Technical support is provided to WHO-UNMIK System Drug Supply Manager on collecting information for drugs, consumables and haemodialysis items for the tender.

The issue of pharmaceuticals and drug supplies has been discussed at several Health Policy meetings and key points have been incorporated into the draft health policy paper.

WHO Pharmaceutical unit is providing support to the DHSW Kosovo Drug Regulatory Agency (KDRA). An organigram and an inception plan have been developed for further consideration.

Procurement of Drugs

The WHO participates at meetings with European Agency on Reconstruction (EAR) within the Department of Health (DHSW) on the preparation for the procurement of Pharmaceuticals. The unit co-ordinates and provides support to the KFK &EAR project.

WHO has co-ordinated with PSF and Doctors of the World (DOW) on TB drug availability.

Quality Assurance

Discussions are taking place and ideas are proposed on the effective co-ordination of drug disposals and quality assurance in the Region. WHO provides advice to DHSW, UNMIK Prizren and Farmakos over QA as well as manufacturing capability of Farmakos.

Mother and Child Health

Staff:

Dr Helene Lefevre-Cholay, Head of Unit (until December 2000)

Dr Jay Gloeb, Perinatal Technical Advisor

Dr Emmanuel Owoso, Reproductive Health Advisor

Dr Gian Paolo Chiaffoni, Neonatologist/MCH Special Advisor

Dr Skender Syla, NPO

Dr Agron Gashi, NPO

Dr Suzana Hadžialjević, NPO

Prof dr Sabit Bajçinovci - SSA

Dr Fevzi Sylejmani - Medical Assistant for Reproductive Health Advisor

Child Health Module of Family Medicine Training Course

A group of 50 doctors from different regions attended this course. The first group was trained in September and the second group in October. Eight MCH facilitators facilitated these courses. The first half of the training concentrated on normal and healthy child and the second part on the sick child, including IMCI training.

Conference in Malta

In October three members of the MCH unit attended a five-day WHO-EURO conference on Reproductive, Child and Adolescent Health held in Malta.

Integrated Management of Childhood Illnesses (IMCI)

The first IMCI national training course was conducted 11-19 December 2000 with 16 doctors being trained. In preparation for this IMCI training course, materials were reviewed, finalised and translated into Albanian.

Promoting Effective Perinatal CARE

➢ Essential Obstetric Care

WHO/EURO organised an Orientation meeting in November on Promoting Effective Perinatal Care which includes both Essential Obstetric Care and Essential Newborn Care educational strategies. EURO support was visible through the attendance and presentations by Dr. Gian Paolo Chiaffoni, a neonatologist/MCH special advisor. A Working Group was formed and a meeting of the Working Group was conducted several days later at which time implementation details were discussed. A second Working Group meeting was held in December. Obstetric health care providers from maternities from five different regions (Pristina, Prizren, Peja, Gjilan and Mitrovica) were present, as well as representatives from governmental agencies (including the Department of Health and Social Welfare) and some NGOs. WHO/EURO materials for this course were discussed, and adaptation and translation of the text materials to be used for the Essential Obstetric Care course commenced in December.

➢ Essential Newborn Care and Breastfeeding (ENC & BF)

ENC/BF training continued in December with about 100 health care workers from five different regions being trained. An ENC/BF workshop on teaching methodology was attended by seven participants. The main objectives were to train additional facilitators for future training courses and to involve key people in the implementation of ENC/BF. The training methodology was interactive vis-à- vis discussions, case studies, participant and video presentations.

The first round of follow-up visits was completed with visits to 18 maternities. Problems and needs envisaged were discussed with doctors and encouragement and support was provided to them. They were encouraged to make changes in their clinical practices as presented during the training.

A system of a maternity visiting a maternity of another district was used for the follow-up system, which required considerable logistic organisation.

A half-day training on “Technical Use of Incubators” was organised in Peja, Prizren, Gjilan and Mitrovica with ten to twelve participants being trained from each maternity. Among the staff trained were gynaecologists, neonatologists, paediatricians, midwifes, neonatal nurses and actual staff responsible for neonatal care.

Survey on Malnutrition and Anaemia

A survey on malnutrition and anaemia amongst hospitalised children from 1 to 59 months of age was conducted at five regional hospitals in the Paediatric and Infectious Disease Departments in Pristina, Gjakova, Gjilan, Peja and Prizren. Over a two-week period of time, a total of 363 children admitted to these departments were evaluated. The outcome indicators identified are being analysed in preparation of the final report. Time was taken to prepare the survey materials before implementation of the study.

Reproductive Health

The Unit continues to collect data from all maternities in Kosovo, as well as update the Summary Table of natality data for ready presentation and analysis. Evaluation of maternity needs and resources continue.

Following the development of educational materials, the first TOT in Safe Motherhood and Family Planning for General Practitioners and Midwives was planned, prepared and conducted.

Reports

The Mother and Child Health Unit has developed drafts of “Healthy Start in Life “ and “Health of Young People” for incorporation into the Action Plan 2001 for W\HO - Kosovo.

Mental Health

Staff

Dr. Liliana Urbina, Mental Health Officer

Mr. Aliriza Arënliu, Mental Health Assistant

Dr. Ferid Agani, SSI full time

Mr. Halil Xhema, SSI part time

Dr. Jose Filgueira Lois, Consultant

Ms. Devora Kestel, Consultant

Ms. Valbona Saliuka, Consultant

Mental Health Task Force Meetings

Regular task force meetings were held where the strategic plan was discussed. The task force focused especially on finding the possibilities for getting new staff members for the future mental health centers (Ferizaj/Urosevac, Gjakova/Djakovica). In further discussions with Human Resources unit of DHSW it was agreed to do the redistribution of staff from the departments or health structures that have surplus of manpower. The Task Force adopted a short version of strategic plan that is to be submitted to the Department by January 2001.

Legal aspects in Mental Health

The working group continues meeting regularly. The draft regulation for forced treatment has been sent to WHO/MH/EURO and HQ for comments. The draft will be discussed during February 2001 with consultants coming from the support centers, WHO/MH/EURO and HQ.

Children Mental Health

The working group continues to meet regularly to discuss the proposal for a strategy to establish a network and to develop children and adolescents services of mental health in elaboration. The proposal will be sent to the Management of Mental and Brain Disorders Unit in the MH Department of WHO/HQ for their comments and suggestions on how to proceed.

Brief report cities

Consultants from support centers in Trieste (Italy) and Asturias (Spain) that were matched with two Kosovar cities: Gjakova/Djakovica and Mitrovica are in place. During the initial phase of their mission, lasting one month from November 20th until December 20th, several activities, such as training of the mental health staff, co-ordination of NGOs and other agencies, organisation of activities in the services and the support in de-institutionalisation were followed up. Together with the Mental Health officer, a detailed plan of action in the frame of the collaboration was prepared. The consultants are expected to return for another two months period in February. Reconstruction continues of the centre in Gjakova/Djakovica with the expected deadline date of December. The tender for the mental health centre in Ferizaj/Urosevac has been organised, and a company selected. The contract was sent to EURO for approval. The land for the mental health centre in Mitrovica has been identified and the equipment for the centres has been ordered.

Promotion activities

Two informative seminars about the mental health strategic plan were organised for nurses working in mental health services. Several Conferences to raise interest on mental health among health workers were organised in Gjakova/Djakovica. Participation to the elaboration and distribution of Kaspar Hauser continues regularly. The unit participated in several radio and TV broadcastings and newspaper articles for local diffusion.

Co-ordination meetings

Regular co-ordination meetings in Pristina continued. In Peja/Pec two mental health co-ordination meeting were held. In Prizren a presentation of the mental health strategic plan was given at a conference organised by UNICEF. Co-ordination meetings are held locally in Mitrovica and Gjakova/Djakovica. Individual meetings with local and international NGO, local professionals and authorities and UN Agencies are frequently organised according to the needs.

Minorities

WHO mental health unit made several contacts with Serb mental health professionals in Cagllavica and Mitrovica. The strategic plan was shared to obtain their comments and opinions. Concrete support was offered to improve the access to mental health services to the population living in enclaves: material and technical support for the training of PHC and MH staff and for the organisation of home care services and outreach teams. The professionals are available to collaborate but the unstable and unclear political and administrative situation delays the interventions.

Meetings

The unit met with the Swiss authorities regarding their interest in supporting the mental health activities in Gjilan/Gnjilane region. A meeting was organised by UNMIK/DHSW for regional advisors, hospital managers, staff from the central office in Pristina to discuss and organise the implementation of the mental health strategy.

Shtime/Stimlje meetings

WHO/MH unit is supporting the work of de-institutionalizing Shtime/Stimlje. A team was formed to specifically work on supporting the staff of the institution in organising rehabilitation programs for its residents. It was decided that a space inside of Institution would be rehabilitated as centre for rehabilitation where a home environment will be ensured in order to prepare the residents to live outside of institution. The consultants working in the demonstration projects (Mitrovica and Gjakova/Djakovica) are especially responsible to connect the projects within the institution with those in the community. DOW-USA is continuing with its project of transferring 10 children from Shtime Institution to community based protected apartment. ICRC continues the program of reunion of families. The Norwegian Red Cross ensured collaboration until December 2001.

Materials

The “ICD – 10” manual for GP’s (mental health diagnosis and treatment) has been translated and submitted for printing to be ready for the training of GP’s in family medicine in January and February 2001. The mental health module in Family Medicine has been finalised and submitted.

Environmental health and public health service

Institute of Public Health

Staff

Dr Matthias Reinicke, IPH Co-ordinator,

Barbara Pearcy, Public Health Officer,

Peter Kreidl, Epidemiologist

Dr Xhevat Jakupi, HIV/AIDS assistant

Rudolf Schmitt, Consultant

Dr Bahri Tigani, Tuberculosis Consultant

Truus Derks, Consultant

Integration into Primary Health Care

A WHO representative from IPH is participating in meetings of the Gjacova Municipal Planning Group. The objective is to develop a strategy for implementation of the new directive for decentralisation of health care services to the municipal level. Public Health activities including food and water safety, immunisation, health promotion and disease surveillance will become municipal responsibilities from March 1, 2001.

Tuberculosis

Translation of the registration forms into Albanian has been completed. Translation into Serbian is still ongoing. WHO will print copies for distribution. The National TB Plan of Action for 2001 has been drafted and submitted.

UNMIK has agreed to pay a supplement to the Regional TB Co-ordinators, as well as pay their travel costs for attendance at meetings of the Commission. The National TB Co-ordinator still has no official office to work from, as UNMIK (DHSW) Peja is unable to provide him with a suitable space in the Regional Offices.

A meeting took place to discuss the future of the TB Hospital in Peja, which was attended by Deputy Director of DHSW, Regional UNMIK Health Advisor and local stakeholders. It was agreed that minimal rehabilitation of the TB Hospital must take place to provide adequate conditions for the patients during the winter period and that an extension to the main hospital would be built with sufficient space to accommodate inpatients, outpatient and laboratory requirements.

HIV/AIDS Committee

The primary focus concentrated on World AIDS Day on December 1, 2000. An HIV educational poster , prepared by the health promotion unit of IPH was distributed, and WHO supported IPH in the various AIDS Day activities, including a panel discussion, and a Anti-AIDS concert in Pristina. The HIV/AIDS commission was officially mandated by the Department of Health and Social welfare to develop a national HIV/AIDS prevention program. The newly established UNAIDS Theme Group in Kosovo supported the HIV/AIDS committee and requested the inclusion of all stakeholders of Kosovo’s society into the committee’s work.

In December a KAP survey among 30 schools was carried out to get more info on knowledge, attitude and practice on HIV/AIDS and STIs.

Laboratory Commission

A Laboratory Commission has been established to develop an overall strategy for laboratory services and advise the DHSW on future policy. Levels of service, equipment required, quality control, safety issues and the control of the private sector will all be addressed. Members of the Commission include representatives from laboratories in primary, secondary and tertiary facilities, IPH, clinicians and the private sector. Terms of Reference have been drawn up and will be submitted to the DHSW for approval.

Food Safety (with Environmental Health)

The Peja Institute, under the Ministry of Agriculture (MoA) had been re-opened and was carrying out food and water testing. Comparison of the activities at the IPH, and the Peja Institute, revealed that the IPH has a much greater capacity and expertise, due mainly to inputs from WHO. Discussions have commenced as to how food safety should be administered in the future, the division of responsibility between the two Institutes and the feasibility of having an independent authority.

A course for 20 Food Inspectors took place from the 16 to 20 of October 2000. Rudolf Schmitt (SSC) provided the training that included 12 participants from Kosovo Protection Corps, 3 from Pristina Food Inspectors and 5 from the Kosovo Control.

A visit was arranged for Dr Shuretta (food microbiology) and Dr Tahira (food chemistry) from the IPH to visit the Institute of Public Health Protection in Skopje. Interestingly the visit revealed that the methodology and standards used for microbiology in the IPH in Kosovo are in fact more up-to date than those in Macedonia, where Yugoslavian methodology is still being used. The visit also provided the opportunity to visit some of the firms supplying laboratory equipment and consumables. A sustainable source of laboratory consumables is urgently required. UNMIK has agreed to provide a budget for this in 2001.

Recommendations

An assessment and training on food chemistry for food inspectors is a priority if food inspection system is to be brought up to speed. This can further be enhanced through the organisation of a visit to the Institute of Public Health in Slovenia. A follow-up on Administrative Instruction on Food Safety and MoA should be organised.

An assessment of activities of sanitary inspectors could further identify the training needs. A follow up on suppliers of consumables remains an additional recommendation.

Clinical Microbiology

An 8-day training course in medical parasitology commenced on the 21 November for 7 laboratory technicians. Two technicians from each of the regions (Mitrovica, Gjilane, Ferizaj, Peja, Prizren, Gjacova, Pristina) were attending. A similar course for a further 7 participants will follow in December. Previously technicians have only been involved in processing specimens, not in reading slides. Training technicians to enable them in performing more of the routine analysis will free up the microbiologists to perform essential clinical, supervisory and management functions.

Dr Gjyle Osmani, Microbiologist in charge of clinical chemistry was on a two week 'study tour' to Herlev University in Denmark in November. The main objective was to observe how a routine clinical microbiology functions in a more developed country and the role of the medical microbiologists and laboratory technicians in the day-to-day activities of the department. The visit seems to have been a great success and a work-plan has been written for development of the laboratories and staff in Kosovo. This includes daily meetings of senior staff, training seminars for technicians, introduction of standard methodologies, improved safety standards and reorganisation of working procedures and laboratory layout. A great deal of support will be required if plans are to be realised.

Environmental Health

Staff

Dr Philip Rushbrook; Environmental health co-ordinator (until October)

Sarah Gayton, Environmental Health Assistant,

Geraldine McWeeney, Hygiene, water and sanitation adviser,

Marie Claire Durand, Water Inspector and Regulator

Susan Ashmore, International Trainer in Health Promotion

Ardita Tahirukaj, Health Care Advisor

Candice Chandra, Healthcare Waste Consultant

Dr Selvete Krasniqi, SSA

Waste Management

Dr Philip Rushbrook, chaired first technical workshop on landfill management for UNMIK Public Utilities Department which was attended by EAR and their consultants, GTZ, DANIDA and the Regional UNMIK. Meetings continue with Prizren Public Utilities Department regarding waste management Actives and the healthy village programme.

A first draft of Guidelines on Minimum Standards for Solid Waste Disposal to Land Produced and been produced. Part 1 contains the improvements to existing Municipal Waste DumpSites.

WHO provided specialist advice on waste management activities in 2nd Kosovo Technical Workshop on Solid Waste Management. Similarly, technical advice was provided to EAR on funding aspects for waste management actives in year 2001.

Chief nurses from Pristina hospital were taken to Pristina landfill site to show them where their waste ended up if they did not manage it properly.

Health care waste management

Negotiations are ongoing regarding allocation of land for the incinerator to be built upon in Gracienitca. Additional proposals have been submitted to Pristina Regional health for incinerators. Works on Mitrovica incinerator are completed; however, challenges still remain with delays with fuel. Health-houses in Pristina region with the assistance by WHO and KDRA destroyed expired drugs.

Water quality and regulation

Members of the Unit travelled to Peja region to discuss with city’s director of water company the contract, chlorination and points on network for future sampling. Similar discussion took place in Prizren region. Discussion took place with Regional UNMIK WATsan advisor about water quality in the region. Emergency solutions are being sought on problems with E Coli contamination and lack of chlorine.

WHO visited the IPH, water company, UNMIK Environmental Officer and Vushtri water Company Mitrovica to discuss an outbreak of 3-400 cases of diarrhoea that has been reported, reservoir levels are low and there is no chlorine in the drinking water.

The unit participates at BI-weekly meetings of the WATsan commission and meeting about water quality control. A meeting took place with EU Reconstruction/IPH/WHO/ to discuss rural water control, collection of data on epidemiological situation and water quality.

In October, Sanitary Inspectors were trained on drinking water quality control in Prizren, Peje, Gjakova. Training was undertaken on water sampling topics such as how to undertake a sanitary investigation in the field and how to collaborate on local and regional level. Case studies were also undertaken. Prior to the training the Unit was involved in the development of training programme. A second training of sanitary inspectors is being organised.

A meeting took place regarding the water quality control Contract: Batlava/WHO/IPH. Batlava is refusing to sign new contract with IPH because it has been suggested they should pay for water testing. Batlava proposed to undertake water analysis and IPH bacteriological water control. Batlava at present is ignoring the Administrative Instruction (AI) on drinking water quality control.

WHO gave a presentation to UNMIK Public Utilities Department Water Enterprises on Drinking Water Quality and Regulation in Kosovo, which was well received.

Healthy Village Project (HVP)

Healthy Village works with many different agencies found in Kosovo. World Vision met with WHO team to confirm details of their implementation of the HVP. Gjilane has been decided to become Phase 2 area for the HVP implementation and Peyer will no longer be the Phase 2. A meeting providing an overview of the HVP was given to UNICEF, IMC, WV, Oxfam, EU, CAD. Oxfam activities in Mitrovica are being assessed as well as the potential of future Healthy Villages. Recommendations put forward to Oxfam have been noted and changed. Healthy Village assistant working with Oxfam in Mitrovica shall develop skills and advise on activities.

WHO was approached by UNMIK Pristina regional Health Advisor and Obilic Municipal administration to implement the Healthy Village Project in Plemintina and Babin where high-level diarrhoea diseases are present.

Trainers and the training area for Serbian Health motivators for the WV Lipjan HVP Project have been identified.

Various trips to the field have been organised. A visit to Gjakova to inspect water pipe factory and negotiate costs took place. A Donor tour with 20 members of IPH was organised.

The training plan for training of IPH and NGO staff involved in HVP was developed, the training room was identified and schedule was finalised.

Update of HVP progress presented to the Commission on Health Education.

Health Promotional Unit Development

WHO secured a verbal agreement with IPH for HPU to commence a joint training programme. WHO will focus on community Nurses while IPH will focus on Doctors.

Mitrovica Region has been identified as the first area for training. Methodologies, water sanitation and waste and planning to be first areas of target.

Liaison meetings with family medicine and WHO Health Promotion consultant and HPU (Dr Begoli) in IPH continued. The unit met separately with IPH regarding DFID programme and possible collaboration. Main Health Promotion topics and priority areas were identified.

Co-ordination meetings continue over discussion on training of health education for IPH and Main Family Health Centre staff. The meeting group agreed the former would participate in training the latter (patronage nurses), which will conduct community outreach health promotion method of training. Clarification is needed on positions and time scale. Dr Bushniacu, the director of IPH, supports the training and there is co-operation with the HPU IPH. The initial training is to include Mitrovica, Skenderaj, Vushtri, Pristine, Gllogoc, Podujeve, Lipjan, and Stimle. All of these municipalities have been visited and Patronage nurses have been identified.

A co-ordination meeting with Helsinki Group advisors allowed sharing of information on training goals to avoid duplication in our effort. Their six-month TOT training will focus primarily on improving clinical skills.

Regional Public Health Advisors

Field Office for Pristina, Gjilan

Staff

Regional Public Health Advisor, Dr Arturo Silva

Public Health support and management

WHO maintains field offices throughout the Kosovo area. The RPHA provides support and technical advice on daily activities addressing public health requirements and programmes. Dr Silva co-ordinates activities among the different regions through the national and international RPHAs. The RPHA participates at Pristina Health weekly co-ordination meetings in the Regional Health Office with all the directors of Health Houses and Dr Sardar. Co-ordination of activities and the advice provided on Health in the Pristina regions is regularly discussed. Dr Silva provides support and technical advice to the Health House directors on the improvement of management in primary care level in both regions. The Health Houses (Ambulantas) in Pristina and Gjilan regions are regularly visited in order to follow up the different WHO Programmes and to support their implementation in the field.

Polio Campaign

The first Polio Campaign was co-ordinated and supported through different activities that lead towards the adaptation of the best strategy for the campaign in all regions. Results of the immunisation activities are being evaluated in order to improve the coverage of the target group.

Minority Issues

The issue of minorities is of a priority concern in the region. Dr Silva is responsible for the minorities in Pristina and Gjilan regions where a list and a map of all the minorities’ areas are being developed. The planning of a strategy to incorporate the minorities into Primary and Secondary care is in progress at the same time as considerable time and effort is being expected from all health workers in the Public System in order to complete this project. Dr Silva continues to visit all the minorities and vulnerable groups in Gjilan and Pristina regions. The WHO office contracted a Serbian driver and translator to facilitate visits to minority areas.

Co-ordination between Dr Silva and NGO Heads of Mission continues on activities in the minority areas. Dr Silva continues to discuss with the Deputy Co-Director at the Department the commitment of joining efforts for the integration of the Minorities to the Public Health System.

Outbreaks of diseases

Together with IPH, Obiliq Municipality was visited to take water samples from different resources, including a Gypsy camp located in this area, due to a reported outbreak of diarrhoea and hepatitis in the Plemetina Ambulanta.

WHO Environmental Program

The RPHA co-ordinated activities on the instalment of 3 incinerators for biological waste planned to be ready to use in December in Donja Gusterica, Gracanica and Kosovo Polje.

Mental Health

Discussion on the implementation of the WHO Mental Health Program for the minority population took place with the responsible contact people in Gracanica.

Field Office for Gjakova, Peja and Prizren

Staff

Dr Anne Ancia, Regional Public Health Adviser

Dr Xhevat Kurhasani, Regional Public Health Adviser

Dr Xhevdet Xhemajili, Regional Public Health Adviser

Dr Osman Zhuri, Regional Public Health Adviser

Public Health support and management

The office supports the organisation in various activities. The field office is discussing the master plan for Family Medicine and the transfer of Primary Health Care to municipalities. Several working groups, based on topic or program areas, have been established to define in practice the smooth application of the document on the municipal level.

The field office continues to meet with UNMIK on a regular basis to discuss and solve ongoing issues. The RPHA attended a Workshop and is involved in UNICEF discussions on their future goals, strategies and resources needed for the next decade in Kosovo.

Polio Campaign

The field office supported and co-ordinated the first POLIO campaign in Peja, Podujevo and Shtime areas. The campaign was considered to be a success.

WHO Environmental Program

Discussions are ongoing with the municipal health director and directors of health structures regarding more regular and efficient garbage collection at the municipal level. Implementation of medical waste management according to WHO recommendations are being discussed. NGOs have been contacted to increase the number of incinerators at the main health family centre.

IPH

The RPHA office supported IHP through the development of a strategy for distribution of inherent cold chain and through participation in the selection of ambulantas for the implementation of the integrated EPI program. Improved data collection of newborns will be included in the EPI program. Discussions are taking place with IPH to discuss the preparation for the AIDS day. The issue of infectious disease ward in Peja remains an issue.

Mental Health

It has been recognised that further support to the mental health program at the district level is needed in order to ensure better co-ordination of the various and numerous stakeholders. A committee has been set up in Peja to support chronically ill mental patients that do not have access to the health structure at the present. Weekly meetings of the Gjakova mental health commission were established to follow up the mental health pilot project. Nurses have been recruited and are awaiting training. The community based mental health centre will be completed by the beginning of January and the office is finalising its organisation and the distribution of responsibilities for different parts of project.

Health Policy

The field office supported the facilitation of the National Health policy conference in Pristina and the participation of Serb doctors in a conference in Mitrovica.

Mother and Child Health

The RPHA participated at a workshop on Promoting Effective Perinatal Care (PEPC) strategies in Kosovo.

RPHA supports the MCH program through the collection and following up of data on deliveries in the maternities as well as recommendations from the MCH unit given during their visit to maternities in Prizren and Peja. RPHA initiated the assessment of access to health care deliveries in minority areas.

Field Office for Mitrovica

Staff

Regional Public Health Advisor, Ms Mateja Kozuh Novak

Mother and Child Health

The WHO staff visited several international and local NGOs to discuss the preparations on the winter conditions in the distant villages. Managers of health care facilities were encouraged to collect data on pregnant women in those villages in order to prepare a plan for safe deliveries in the winter months. The villages in the mountains are not accessible to health care staff in winter.

WHO Environmental Unit

The possibility of Mitrovica becoming a Healthy Village pilot project was discussed with the WHO Environmental Unit.

Polio Campaign

The first Polio Campaign was co-ordinated and supported through different activities in the region and was considered to be a success in Mitrovica. Collaboration with UNICEF was found very productive.

Lead poisoning

With the professional assistance of the WHO expert, Dr Zbigniew Kolacinski, UNMIK health care administrator ran the second blood sampling for the testing of lead poisoning. The Mitrovica WHO staff assisted in facilitating the collaboration with the local health care professionals and with the population at risk. Recommendations were prepared for further activities in this area. WHO staff’s initiative to organise meetings with key persons and the assistance of IMC in the gypsy camp, brought about the commencement of the project.

Minority Issues

Dr Stalhandske, Deputy Co-Director at the Department of Health, stressed in a meeting with health care representatives in Mitrovica and the RPHA the expectations of UNMIK regarding the transfer of WHO programs, running in the South to the North. More efforts should be done to transfer the programs, which are already running in the South to the North. At present, Serbian health care professionals are not very collaborative. However, first signs of their readiness to collaborate have been noticed.

III. ADMINISTRATION

Administration and Finance

Staff

Mr Ehsan Nakhla, Head of Administration and Finance

Melita Bytyqi Cana, Finance Assistant

Besnike Ukmata, Personnel Assistant

Edona Kryeziu, Administrative Assistant

The administration and finance staff supports the Pristina office and the field offices in Kosovo on financial, personnel and administration matters.

Information Technology

Staff

Edward Poultney, Information Officer

Blerim Kroci, IT Assistant

Erman Morina, IT Technician

Bukurije Selimi, Database Clerk

The IT staff supports the office activities through the provision of information and technology support.

Health Talks is a BI-weekly newsletter providing a record of developments in the health care sector in Kosovo. It is translated into Albanian and Serbian language and is available on the internet. It also provides a platform for NGOs working in the health care sector in Kosovo. It has a wide audience among donors, both in and outside of Kosovo, which includes donors, governments, medical and non-specialist media and the general audience.

Family Doctor is a WHO Kosovo office publication prepared and published by the Information Officer on a regular basis to inform everyone on the office’s ongoing programs, regular activities and points of interest within the health field. It is translated into Albanian.

The unit greatly contributes to ensuring proper software is being translated and available to the staff in Pristine as well as other offices in Kosovo. Training Materials are prepared in electronic form for publishing purposes by the staff.

Logistics Support

Staff

Nicolas Daher, Logistics and Security Officer

Blerim Komoni, Senior Logistics Assistant

Alket Goxhabashi, Worshop Co-ordinator

Ramiz Shala, Senior Security Guard

Majlinda Tyrbetari-Morina, Receptionist

Besa Ymeri, Receptionist

Lindita Abazi, Office Clerk

The staff’s ongoing fieldwork requires their regular visits to the field and allows the offices throughout Kosovo to remain in touch through ensuring regular and secure mobility to required destinations by our logistics team which includes local drivers.

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