Healthcare in Kosovo

Primary Health Care relates to the professional health care services offered to the community, usually from a nurse or general practitioner. It covers a wide range of health and preventative services such as supporting and taking care equally for all community, including those who have lower income, provide health education, counseling disease prevention, screening and promoting better living environments.[15][16] Primary health care became a fundamental concept for World Health Organization as a result of the Alma Ata Declaration (1978).[17] Since the Declaration of Alma-Ata, health situation at country level has gone through major changes. There have been many modifications in demographic profiles, socio-economic environment and reducement of risk exposure and common diseases.[17] Primary health care is available for individuals and families, coming from different municipalities, with affordable costs that can be covered by the Government funds as well as community.[18] Kosovo consists of an overall 36 municipalities, all of which has their own PHC medical centers. Kosovo Primary Health Care is organized in two separate levels such as: Family Medicine Centers (FM) and Ambulatory Health Care Units.[18] Geographically isolated municipalities, have established also some maternities, such as Women Welfare Centers, that serve for women emergency well-being cases.[18]

The table below shows main Family Medicine Centers in Prishtina and their locations.[4]

The table below shows Ambulantory Medical Units in Prishtina and their locations.[4]

Lack of family medicine specialists

Family Health Care Centers in Kosovo are in need of 1,000 family medical specialists. Currently there are approximately 500 family doctors providing primary health care services.[19] Primary Medical Centers usually deal with problems such as, short data on citizen registry, incorrect addresses and a large number of community migration from rural to urban territories. Recently, the Ministry of Health has signed an agreement with British College, to train Kosovo graduated doctors in UK.[19]

Secondary health care refers to a higher level of health care system, in which patients from primary health care are referred for more specialized treatments.[20] Secondary health care level includes medical services provided by a specialist or more advanced facilities, upon referral from a primary care physician that requires more specialized knowledge, skill or equipment than the primary care physician. Secondary prevention programs identify and treat asymptomatic people, who have already been exposed to different risk factors or have any pre-clinical diseases, without any clinical symptom. These activities are focused on early screening of asymptomatic patients, that are prone to develop the disease without any possible prevention or treatment.[21] Screening tests are an example of secondary prevention activities, since they are performed even on patients who did not manifest any clinical symptoms of diseases, such as: hyperlipidemia, hypertension, breast, prostate cancer and many others.[21] Secondary health care is offered by regional hospitals in municipalities such as Mitrovica, Peć, Gjakova, Prizren and Gjilan.[22]

Besides University Clinical Center of Kosovo (UCCK), which is the only tertiary health care center, there are also seven regional hospitals that offer secondary health care services. Most of referred patients to UCCK come from regional hospitals.[23] Regional hospitals in Kosovo are:[24]

• Prizren’s regional hospital
• Peć’s regional hospital
• Gjakova’s regional hospital
• Ferizaj’s regional hospital
• Gjilan’s regional hospital
• Mitrovica’s regional hospital
• Vučitrn’s regional hospital

Tertiary health care is the highest specialized medical level, which offers more complex procedures and treatments performed by specialists.[25] Tertiary activities involve treatment of already established diseases, manages to restore patients to their highest functional level, minimizes negative effects of disease and further complications.[25]

Kosovo's tertiary health care specialized medical services are offered by medical institutions such as University Clinical Center of Kosovo, University Dentistry Clinical Center of Kosovo, National Blood Transfusion Center, National Institute of Labor Medicine, Medical Center for Sport and Recreation, National Institute of Public Health and Faculty of Medicine, University of Pristina. Many tertiary health care services are mistakenly used instead of primary and secondary health care services from Kosovo inhabitants.[26][27]

Universal Clinical Center of Kosovo - Emergency department[28]

University Clinical Center of Kosovo is the main tertiary health care institution located in Prishtina, which offers most specialized medical services. It consists of Emergency Care Center, 12 clinics, National Institute of Public Health, Central Pharmacy, Private Pharmacies, and Institutes like Anatomy, Pathology, Physiology, Pharmacology and Toxicology.[5]

UCCK Clinics - Human Resources

This table shows the overall human resources working in University Clinical Center of Kosovo, including specialized doctors and nurses for 12 clinics, Emergency Care Unit, National Institute of Public Health Kosovo and Central Pharmacy.[5]

National Institute of Public Health Kosovo[29]

National Institute of Public Health (NIPH) was established on 5 June 1925 and it is the highest medical, professional, and scientific institution.[29] The institution organizes and applies the strategy of public health hygienic-sanitary measures, prophylactic-epidemically measures, social-medical, health education, EPI (expanded program on immunization), health promotion, water, food and air quality controls, health policy, economy of health, and develops scientific research works in the territory of the Republic of Kosovo.[29] Hence, the Institute is known as the educational base of the Faculty of Medicine and is divided in five departments: Epidemiology, Human Ecology, Social Medicine, Micro-biology and Health Information System; Kosovo School of Public Health.[29]

Development history of NIPH

The 1920s were characterized by very bad medical conditions in the Balkans.[29] In general, based on the Kosovar health care condition and the overall public health situation, a decision was made to establish hygiene and epidemiological services in the city of Peć with the "Rockfeler" fund support from the U.S and on 5 June 1925 this service finally began to work. On the same day, basis were set for Preventive Medicine in Kosovo and 5 June is marked as a festive day for founding of the Institute of Public Health.[29] After that date, sanitary stations, hygienic and microbiological or epidemiological services were established in Pristina, Prizren and Mitrovica. In these units there was a great lack of specialized staff (except in Prizren), but health services were performed by health employees with medical school degrees.[29] In ancient Prizren, during 1923/1924, it was established the highly efficient bacteriological service which provided services to the entire territory of Kosovo at that time (a part of Sandžak and Montenegro).[29] Yet, Dr. Isuf Dedushaj stated that it was only bacteriological service which later developed into the hygienic-sanitary services in order to be later transformed into the Regional Institute of Public Health of Prizren.[29] During the years 1946/1947, the first Albanian doctor Dr. Durmish Celina started his work by developing educational-medical activities.[29] At that time, Dr. Daut Mustafa lectured professional courses in the medical high school too.[29]

The Inheritance of many infectious diseases had damaged the country in terms of economy, culture, education, and health.[29] Prior to World War II and especially after it ended, the health condition and the circumstances in Kosovo were extremely difficult.[29] There were many serious infectious diseases such as: malaria, typhus, louse, tuberculosis, measles, meningitis, diphtheria, and other diseases which led to killing hundreds to thousands infants.[29] It is important to emphasize the fact that in Kosovo in 1940 there were 5 hospitals with 390 beds, 36 different ambulatory medical and preventive services that had 5 sanitary-epidemiological stations, from which only three had worked.[29] Dr. Isuf Dedushaj stated that in all these medical institutions there were 38 doctors, 20 private pharmacists, one dentist, and around 85 medical workers that have learned from medical practice and courses offered at that time.[29] After World War II, Kosovo had terrible living conditions and the illiteracy rate was about 98%.[29]

In the early 1946, Kosovo had five hospitals with 333 beds, on average 0.4 beds per 1,000 inhabitants, 9 doctors (foreign and local), 15 pharmacists, 6 medical technicians, 11 cleaners, and 27 other medical workers with lower qualification.[29] The medical protection was offered in 8 cities, 3 villages, and 1 anti-tuberculosis dispensary, whereas in the dental prevention program there were 4 dentists.[29]

University dentistry clinical center-Kosovo[30]

University Dentistry Clinical Center (UDCCK) is located in Pristina and it is the main medical, educational, and scientific institution in the field of dentistry in Kosovo, and their mission is to maintain and develop good oral health.[30] Their staff participates in different local and international meetings, training, professional and scientific conferences.[30] The outcome of these activities is primarily increasing the efficiency of the dental procedures in order to maintain with the contemporary developments in dentistry.[30] The application of the Health Information System in UDCCK endorsed their work in developing in terms of dental medicine, since it provides reliable data, in collaboration with the Ministry of Health in Kosovo, to establish dental medicine welfare in general.[30]

Development history of UDCCK

The history of Kosovo dental medicine began with the practical training in the laboratory of Medical High School in Pristina.[30] At that time, dentistry section was established where 96 dentists worked.[30] The Section of Dentistry was organized in independent working units and they were: Prosthetic Dental Clinic, Tooth Disease Clinic, Mouth Disease Clinic, Preventive Dentistry Clinic, Oral Surgery, Teeth and X-ray Laboratory and Working Community.[30] In Dentistry Section there were 177 employers, 44 doctors, 20 assistants, 9 trainee assistants, 29 dental technicians, 50 medical technician, 15 administrative staff and 32 support staff.[30] The educational and health activities were mainly conducted in the Charitable Humanitarian Organization "Mother Teresa" in Prishtina.[30] Since June 1999, dentistry clinics became part of the UDCCK until November 2003, when an important event for dentistry occurred when the Ministry of Health issued an Administrative Instruction 12/2003, on the Establishment of UDCCK as an autonomous and independent institution from University Clinical Center of Kosovo (UCCK).[30]

Based on the publications of Ministry of Health in Kosovo, there are only 248 licensed private dental clinics, even though there are around 921 registered dental clinics through Kosovo.[31]

Licensed Private hospitals in Kosovo are the following: Special Hospital for Cardiovascular Diseases "Intermed", Specialized Hospital for Cardiovascular Diseases "International Medicine Hospital", and Cabinet Coronarography "Diagnostica".[32]

American Hospital in Pristina[33]

American Hospital is a private hospital in Pristina inaugurated on 6 April 2012. American Hospital in Kosovo is a Bedminster Capital Management Fund investment, based in New York, whose participants are the Government of the United States of America.[33] It is represented by the Office of Foreign Investment (OPIC), the European Bank for Reconstruction and Development and different American investors. It has an area of 3000m2, 4 floors, 30 hospital beds, 3 surgery rooms, 2 maternity rooms, 2 suits with advanced equipment and about 100 employees available to provide professional medical services.[33]

Faculty of Medicine, Decanate-University of Prishtina[34]

University of Pristina was founded on June, 17th 1969, though it started working on December that year. First lectures were held in the philosophic department of the university.[35]

Faculty of Medicine consists of 6 departments such as general medicine, pharmacy, physiotherapy, dentistry, and nursery.[36] The General Medicine and Dentistry studies last 6 years, Pharmacy lasts 5 years, whereas Physiotherapy and Nursery last 3 years.[37]

Initially the Faculty of Medicine in Pristina started off with only General medicine, but 6 years later the section of dentistry was founded. On May, 15th 1996 the Pharmacy section was founded and later on in 2001 the Physiotherapy was founded as well.[38]

Nowadays Faculty of Medicine, University of Prishtina is an integral part of University Clinical Center of Kosovo.

Departments, Students

About 1,985 students attend medical lectures every year.[38] The actual Minister of Health, Prof. Dr. Ferid Agani, stated that "Faculty of Medicine is looking forward to become an independent part of University of Pristina, and the whole idea is to create Biomedical University whose rector will be a doctor, and the six departments of Faculty of Medicine will be transferred to the Biomedical University.[39] If established, the Medical Science Faculty will be the third public university in Kosovo, right after University of Pristina and University of Prizren.[39]

Ministry of Health of Kosovo Organizational Chart[40]

The Ministry of Health[41] operates under the Government of Kosovo in accordance with its Constitution and applicable laws. The Government of Kosovo is composed by the prime minister, vice-prime ministers and ministers.[42] It is located in the centre of the capital of Kosovo, Prishtina.[43] The work of Ministry of Health is organized through the Department of Finance and general Services, Legal Department, Department for Health Information Systems, Department for Health Services, Department for European Integration and Policy Coordination, Department for Strategic Health Development and Department for Health Services in Prisons.[44] The Ministry of Health is responsible, among others, to draft policies and ensure law implementation, promote non-discrimination approach on health care system, sets norms and standards respecting relevant international health standards. The ministry of Health coordinates activities in the health sector including environment protection. Kosovo Health care functions are based on the following principles: equity, quality, equal treatment, sustainable financial conditions, cost-efficient services.[45]

Department of Health and Social Welfare

According to the local government laws, the department of Health and Social Welfare creates strategies for primary health care, diagnosis and basic health care, including minor surgeries, oral health promotion and basic dental care, quality assurance of food and water, ensuring the provision of social services and families within its territory, through the activities of the Center for Social Work (CSW) or by providing financial or other assistance to non-governmental organizations dealing with this activity.[46]

Private Insurance Companies are organized in a joint association called the Insurance Association of Kosovo (IAS).[62] This association was established in 2002 with the agreement of the licensed insurance companies in Kosovo.[62] They seek to improve the insurance industry in Kosovo, to stabilize the insurance market and to offer trainings to the companies.[62] The insurance companies in Kosovo are the following:

[62]