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Kosovo Health Talks 20

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Situation Report
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News Update
UNMIK HEALTH AND SOCIAL WELFARE

Health community greets Sejdiu

Over 100 local and international representatives of health, donor and NGO institutions and organizations met new Department of Health and Social Welfare co-head Dr Pleurat Sejdiu at a reception hosted by WHO last Friday.

Dr Sejdiu, well known to Kosovars as the TV face of the UÇK (KLA) in London, but less known in person due to his long periods away from the territory, took the opportunity to speak with many local doctors and directors.

He was welcomed into post by WHO Chief of Mission Robert Hagan, and by DHSW co-head, Dr Hannu Vuori, who said that the appointment of the counterparts would make a "dramatic difference to the way Kosovo is governed. "

"The UNMIK structure has been a sort of ivory tower. Though there has been substantial consultation with local people we have simply been doing what we think will be good for the people of Kosovo. Now, however, with the inauguration of the Joint Interim Administrative Structure, the every day running of Kosovo business is in JIAS not UNMIK. This is the first step towards a real Kosovo government."

Dr Sejdiu responded that he hoped all parties, local and international, could work together to really achieve improvement in the Kosovar population's' health.

The IAC currently consists of seven members - three Kosovo Albanian political leaders plus four UNMIK members. It is thought the Serb National Council may soon take their seat at the table. All regulations and policies will need its approval and decisions will be taken by consensus or by a majority vote with SRSG Bernard Kouchner having the casting vote in case of deadlock.

Local doctors take up policy challenge

Friday's reception for Dr Sejdiu marks the beginning of a busy programme of meetings workshops and conferences scheduled to take place Kosovo-wide over the next few months as local doctors and health workers take over the drive towards to developing Kosovo's health service.

The first initiatives - a series of six primary care workshops aimed at updating practitioners on the principles and potential of family medicine practice organized by the newly-constituted Association of the General Practitioners of Kosova (see below)and supported by WHO - begin in Pristina on 19 February, while mid March will see a two day UNMIK/WHO conference for hospital and health house directors on governmental and international structures in health and how to negotiate the corridors of power and influence.

New heads change appointment process

Candidates for executive posts in health houses, hospitals and other health facilities will have to wait a little longer to know whether or not they are chosen for interview after UNMIK Health last week altered the process by which candidates will be appointed.

Instead of being interviewed solely by a local committee made up of international managers, UNMIK regional health officers, WHO and other parties which would make recommendations on suitable candidates to UNMIK Health, all executives will now also be interviewed and appointed by the joint co-heads of the new Department of Health and Social Welfare, Drs Hannu Vuori and Pleurat Sejdiu. In some areas, such as Prizren, the changes have meant suspending an already advanced procedure.

The changes in procedure coincided with the appointment of Dr Sejdiu, who says it is important that common criteria are for selection and that the executives chosen command the support of the staff they manage.

It has also been suggested that hospital managers might be placed in a difficult position if they are too closely associated with the selection procedure.

Dr Sejdiu expressed particular concern over the selection process by which the new Pristina University Hospital board was appointed last month, which involved a combination of nominations by fellow workers and 'soundings' taken within and outwith the hospital, reviewed by an expert committee.

The decision to re-appoint all executive positions in health to ensure contractual accountability to UNMIK began in December. However, some are concerned that the appointment process may be being politicized. There have been unconfirmed reports of candidates in the regions being advi sed to join particular political parties if they wish to have any chance of gaining an executive post in the health service.

Department to move and grow

UNMIK Health - now the Department of Health and Social Welfare - is to move once again, this time from its offices on the top floor of the New Government Buildings to the former offices of the state import-export company on Mother Teresa Street, opposite Radio/TV Kosovo. The building is also intended to house the Department of Education. However, though both departments were authorised to move on Monday, dispute over ownership of the building is currently delaying the move.

The new department - which combines health and social welfare - will have a total of 22 international and 24 local staff, mostly matched as counterparts. Recruitment is about to start. There will be units dealing with primary care, hospitals, human resources, health care financing, social welfare and social security, plus five regional offices. The Joint Civil Commission for Health will continue in its consultative capacity and a Commission for Social Welfare is to be established.

To contact the Department of Health and Social Welfare in Pristina, please call the UNMIK switchboard, 038 500 233 or 501 400/397/398/396 and ask for the department

DONORS

World Bank focuses on managing healthcare

After a two week mission aimed at allocating a US$5 million grant across the health and education sectors in Kosovo, the World Bank team identified the development of health financing systems and the skills of those involved in managing the system as a priority for the health element of their funding.

Speaking to the General Health Coordination meeting in Pristina, World Bank team leader and health economist Laura Rose said the US$2.5 million investment available to the health sector was small by Bank standards, primarily because neither Yugoslavia nor Kosovo are members of the World Bank. "But we are investing quite a lot of staff and budget time here in the hopes that there will be a chance for more investment later. At the moment our three main objectives are to develop a health financing system that will improve the efficiency and equity of public financing of health, to build the capacity to carry out these functions and to put in place appropriately trained human resources who can plan health services."

One of the practical projects likely to be funded is the rehabilitation of the Kosovo Health Insurance Fund building as a precursor to re-developing this form of funding.

EU still spending on infrastructure

The European Taskforce still has plenty of money to spend on bricks and mortar in the health sector but is experiencing a dearth of good proposals. Dr Skender Kutllovci from ECHO says NGOs willing to support rehabilitation of health facilities should contact him at Carice Milice 10, Ulpiana, in Pristina, sat. ph: 871 762 106 086

HOSPITALS

New 'hospitals' contravene policy guidelines

An explosion of groups wishing to build new hospitals in various centres around Kosovo is causing alarm in some quarters.

Developments mooted for Vushtrri/Vucitrn and in Rauhovec/Orahovac are two cases in point. In Vushtrri/Vucitrn, the United Arab Emirates has long wanted to extend the health house into a hospital staffed by UAE medics - a plan that would not only contravene UNMIK health policy, but seriously undermine local medical staff. This latter issue has also arisen in Mitrovica where, due to political decisions late last year which closed the main hospital to Albanian staff and patients, Moroccan and French KFOR are now providing secondary care to the Albanian population of the town. While this is essential and valued, none of the 300 Albanian hospital workers have been employed in these facilities.

In a second project Huy, the Belgian sister city of Rauhovec/Orahovac last week proposed they invest a 1 million DM donation in building a hospital for the town. Both Albanian and Serb patients in the town, which is in the catchment area of Prizren Hospital, already have good basic primary health care, according to a recent report by Dr Erik Schouten, WHO's public health adviser for Western Kosovo, though transport to secondary care has been a problem for the Serb community. This issue is currently being resolved with the help of Dutch KFOR, and strenuous efforts are underway to convince the citizens of Huy that their generous support would be better used on other health services in the area.

Both proposals clearly work against the "Blue Book" health policy guidelines, adopted by UNMIK in October last year, which expressly stipulate that no new hospitals should be opened, and international investment should be focused on developing family health centres and primary care which, experience suggests, will use human and material resources more effectively, be more sustainable and have more impact on the health of Kosovars.

A third proposal, for Gracanica where health care for the Serb community has been particularly problematic, has however received the personal approval of SRSG Barnard Kouchner on the basis of essential access. The proposal from Mediciens du Monde Greece and the French Red Cross will see a 40 bed, 60 doctor secondary care facility established shortly in the town.

Fire damages Gjakovë laboratory

A fire in Gjakovë/Djakovica Hospital laboratory destroyed equipment and furniture but luckily left unscathed the new equipment provided by German Government agency GTZ which was awaiting installation. International manager Eivor Akar and laboratory staff have identified an area which can be temporarily used to allow urgent assays to be done until the full laboratory can be renewed.

Huge planning exercise begins

International managers and hospital boards across Kosovo are embarking on a major planning exercise this month. In Gjakovë/Djakovica and Prizren working groups of local staff are already advanced in analyzing each clinical department in the light of the decentralized 2000 budget, both from infrastructure and human resources aspects and to identify development needs.

The idea is to produce 'master plans' which can then be combined to build a comprehensive picture of provision and needs for the whole of Kosovo. International manager Eivor Akar says the Gjakovë/Djakovica board has grasped the project enthusiastically. "We have a lot of working groups and are quite far down the track. People are very stimulated by the work."

According to Prizren international manager Aldo Graziani, this kind of open planning procedure is "a big challenge to individuals and managers. We need to look at performance in the status quo - with the ceiling of the current budget - whether staff have the right qualifications, what we can do in terms of internal training, and then think about how we could make improvements within this situation." This is not the time for a 'wish list from the international community, he added.

New centre fills diagnostic gulf in Mitrovica

UNMIK Health has agreed to allow the development of a diagnostic centre in the health house in the south side of Mitrovica. Currently the 250,000-strong Albanian population are excluded from the hospital sited in the northern predominantly Serb side of the city and have no access to diagnostic techniques such as x-ray and ultrasound.

According to UNMIK/WHO hospitals coordinator Francois Cremieux, the second floor of the health house is being equipped to do secondary care level diagnostics. Two ultrasound machines, supplied by the French Government are being installed, and at least one X-ray table should be operational within two months. The only other x-ray facility available to Albanians at present is a mobile unit operated by KFOR. In the future, it is possible endoscopy equipment will also be made available, after staff are trained.

Cremieux says ironically the difficulties Albanian doctors are facing in divided Mitrovica may put them in the forefront on more modern practice. "The fact that Albanian doctors have no beds is going to change their practice faster than anywhere. They are teaching themselves to treat patients without beds which is exactly what WHO policy recommends."

Dr Sinan Prekazi, leader of the Albanian Hospital team says the diagnostic centre will make a difference. "We are trying to organize our work in the health house. It is difficult with no equipment and no real infrastructure, but we are trying."

But he reiterates that Albanian doctors continue to be willing to work with Serb colleagues and to co-operate on how services should develop for the future. "We worked alongside our Serb colleagues for three months after NATO arrived."

Several departments where colleagues respect each others clinical skills have managed to maintain some links across the political divide (see Mental Health). But, with the heightened tensions of recent days, fledgling medical initiatives between the two communities are likely to be even more difficult for the near future.

PRIMARY CARE

Faculty establishes primary care unit

The Medical Faculty of Pristina University Hospital has opened the doors of the first primary care department in its history. Though early days - the two room unit has yet to be fully equipped - the move marks the faculty's commitment to the goal of improving primary health care and introducing European standards of family medicine. It will be the focus for medical faculty and international curriculum developers working initially on the six month continuing education updating course in family medicine, and later on the development of a full three year specialism course.

As well as office space, the unit will also have a computer room equipped by WHO with internet connections provided by Samaritans' Purse and the Canadian/European Union-funded Intranet Health Clinic to ensure course participants and the medical faculty students have access to research materials and clinical information. Internet connections to the primary care unit and to some of the other offices of the Medical Faculty has already been installed.

Consortium addresses training and funding

A consortium including WHO, International Medical Corps. International Rescue Committee, HealthNet International, Cordaid and Nuova Frontiera have come together to offer technical support to Pristina University Medical Faculty in supplying family medicine training and to find financial support. Several million DM will be needed to take existing general practitioners through family medicine updating and, says WHO primary care coordinator, the best way to assure funding appears to be to pull in a variety of interests. The NGOs and agencies who have expressed interest in joining the consortium will also bring their expertise both to developing the curriculum and providing expert back-up to the outreach training sites which are planned.

The structure of the training process is being finalised, current thinking would see course participants starting the didactic training of the first module - orientation to family medicine - in the medical faculty, then moving in subsequent months, to the regional training facilities which will specialise in a particular module for that subject's classroom training. In between, participants will return to their own facilities to put into practice their learning with the support of trainers and, most important, peer review groups.

For information on any of the human resource developments in primary care, please contact WHO's primary care coordinator Sue Woodward at the Primary Care Unit, or via email: suewoodward06@hotmail.com.

The Association of General Practitioners of Kosova

To all international and local institutions, NGOs and other interested partners

We are glad to inform you that the Association of General Practitioners of Kosova (Asociacioni I Mjekëve të Përgjithshëm Të Kosovës AMPK) - a new local NGO - was formed and registered with UNMIK on 6 December 1999.

AMPK includes GPs of all ethnic backgrounds from all over Kosovo. To date, the association has been joined by 220 GPs and we hope soon to be joined by a greater number. There are 560 GPs in Kosovo according to our information.

AMPK will work to develop a continuing education system within the structural institutions and, through its membership, will strive to provide medical services more efficiently to all the people of Kosovo regardless of political or religious preference or ethnicity.

AMPK will actively participate in the development of a democratic civil society by cooperating, coordinating and supporting other health care-related organizations and institutions.

All AMPK's activities will develop in accordance with the Health Policy Guidelines of Kosovo developed by UNMIK Health and World Health Organization, and it will promote family medicine as the base of primary health care.

All this AMPK plans to achieve through various programmes on health education which we think are very important.

In order to develop these programmes, we will need the support of the international community and other related organizations. We would great appreciate your help

Dr Arben Cami
President AMPK

For further information, and particularly if you are able to offer the Association office space and equipment, please contact Dr Cami on +381 38 24 837 or on benicami_2000@yahoo.com.

ECHO talks training money

The European Community Humanitarian Office (ECHO) is considering the possibility of funding training for family medicine practitioners to the tune of around US$500,000.

Finnish Aid Agency FINIDA has also expressed interest in arranging a large scale primary health care project and will visit Kosovo in late February.

Focus on rehabilitation

The rehabilitation of Gllogoc/Glogovac Health House provides a master class for anyone with an interest in humanitarian reconstruction. The subject of a project by the Norwegian Aid Committee (NORWAC), it illustrates the possible benefits that can be achieved but also the potential pitfalls along the way. It also reveals the need for short term and long term rehabilitation to run alongside each other so that patients can receive adequate care immediately as well as looking to a brighter future.

NORWAC moved rapidly into Kosovo shortly after the return of the population and, in July committed to carrying out major reconstruction and equipment of three health houses, Gllogoc/Glogovac, Obiliq/Obiliç and Fushe Kosovë/Kosovo Polje. In the six months since then the organization, using local contractors, has renewed much of the water system ready for a municipal water system, replaced all the internal sanitation plumbing, repaired the internal waste water system, and completely renewed the electrical and lighting systems. The fuel oil heating was repaired and electrical and gas heaters were brought in to provide a two level back-up system. The building has also been painted outside (work continues on the inside) even down to the varnish on the brick trim. A substantial amount of equipment has also either arrived or is on order.

Yet, when WHO regional advisors visited to check conditions in the maternity unit, the actual patient conditions did not reflect the huge amount of work and investment provided by NORWAC. So where is the problem? According to NORWAC's Kosovo representative Lulzim Shehu, part of the problem is that the project made the assumption that others, including UNMIK Health, would supply essential day-to-day materials. Until recently, he says "the health house didn't have money, it wasn't supplied with elementary hygienic materials, with fuel for the generators we brought in or the heating system, or with gas bottles for the heaters."

Local contractors also met problems with the lack of essential services such as electricity and material delays at the border, says Shehu, which meant activities like window and roof replacement got out of sync with the other repairs. This was to prove crucial when the cold weather hit since the newly repaired heating could not be started safely

No humanitarian project goes entirely smoothly, and NORWAC's experience would, is no doubt, be echoed by many other organizations involved in the fraught business of having to choose to place investment in really long lasting improvement, or fire-fight day to day problems. Perhaps the answer lies in the building of strong relationships between large project holders and a smaller ones who can literally plug the gaps in the short term so that future gains do not endanger present needs.

MOTHER AND CHILD HEALTH

Maternities across Kosovo are finally warm

Over the past two weeks, concerted action by UNMIK, UNICEF, WHO, UNFPA, various KFOR brigades, UK’s Department for International Development, NGOs such as WarChild, International Medical Corps and Mediciens sans Frontieres, with some manpower from the Kosovo Protection Corps, has seen the cold weather crisis in the maternity units in health houses throughout Kosovo turned around. All health houses with now have two warms rooms for delivery and ward care, according to WHO's Dr Kees Rietveld.

In all twelve 5 KVA and three 14 KVA generators provided by UNICEF, several larger generators including three 60 KVA machines from WarChild and a 100 KVA machine from US KFOR, and 19 UNICEF electric heaters have been installed. Generator fuel, coal and wood has been provided by a combination of UNMIK and other sources, and UNICEF has provided training necessary to operate the provided machinery.

In Gllogoc/Glogovac Health House, a team of 10 Kosovo Protection Corps members, equipped with carpentry tools and materials by the UK Department for International Development have been mending broken windows so that the heating already repaired by NORWAC can run safely and carrying out the immediate building works needed to back up NORWAC's long term rehabilitation works of the long term heating system (see above). DfID also supplied 10 tonnes of heating fuel to keep the heating system going until UNMIK supplies are delivered.

In health facilities generally, however, day to day issues are likely to continue to need fire fighting. In one health house, for example, the director decided to buy two dental chairs and other equipment with the money allocated in the budget for fuel for the heating system. In another the director has turned away offers of electric heaters, despite the cold, because he is concerned warm rooms will deter donors from committing to the long term solution of fixing the central heating.

COMMUNICABLE DISEASES

Kosovars underestimate tuberculosis

One of the greatest obstacles in curing TB in Kosovo may be the fact that many people don't take the symptoms of TB seriously enough. This, together with difficulties of access to trained diagnosticians and the stigma against those who suffer TB, are the three key findings of a newly completed study of the knowledge, attitudes and practices related to TB in Kosovo carried out by American NGO, Doctors of the World.

The survey, which involved interviews with almost 1300 people in nearly 600 households as well as 133 hospitalised tuberculosis patients, is part of Doctors of the World five year tuberculosis control project. The findings, were presented to the Institute of Public Health TB Commission last week, adding to the weight of evidence being considered in the development of a Kosovo-wide TB strategy.

The results show significant numbers of people - some 10% of the general population and almost 50% of diagnosed patients - would delay reporting TB-like symptoms until they become extreme, with 'not necessary' was the most cited reason.

"People know they should seek help for TB-like symptoms but don't always do so because they underestimate the severity of TB, attribute the symptoms to a common cold, or fear the consequences of a negative stigma if they are diagnosed with TB," says Sarah Jane Sheldon, DOW TB education coordinator. "Some people coughed for a year before they saw a doctor."

Over a quarter of Kosovars do not know any symptoms of TB while patient knowledge of the characteristics of TB is "strikingly lower" than that of the average population, says Sheldon. Less than 60% of patients knew TB was contagious, compared to over 80% of the general population, and a quarter of patients expressed little worry at their diagnosis.

Symptoms of
Tuberculosis
Productive cough
Night sweats
Fever
Weight loss
Fatigue

Most patients did, however, say they knew the importance of taking all the drugs prescribed - a crucial factor in preventing the development of multi-drug resistant tuberculosis.

When it comes to negative stigma, one in 10 of the general public and over a quarter of TB patients believe it is 'shameful' to have tuberculosis. Interestingly, says Sheldon, this view was more prevalent among urban educated people than rural uneducated people, indicating that knowledge will not be the only solution to breaking down prejudice and encouraging people to come forward for treatment.

"If people won't readily come forward to seek care for suspected tuberculosis, TB cases must be reached and managed in the community," says Sheldon. However this goal is complicated in the short term by the lack of training among general practitioners in recognising and treating tuberculosis. A key element of the Kosovo strategic plan for TB is the development of community diagnosis and treatment expertise.

For further information on TB, please contact Sarah Jane Sheldon on 0176 201 1135 or Amy Kravitz at the WHO office.

Literacy levels surprise

According to the Doctors of the World Knowledge Attitudes and Practice survey on Tuberculosis, only 70% of rural population and 85% of the urban population are literate, while less than 40% of the urban population, and 20% of the rural population has completed secondary school. "These literacy levels are lower than expected," says Dr Sarah Jane Sheldon, Doctors of the World TB education coordinator.

PHARMACEUTICALS

Changeover plans should assure supply

WHO, UNMIK, and ECHO have agreed on the pathway needed to ensure a smooth transition from the ECHO funded, Pharmaciens sans Frontieres-led primary health care drug distribution to a Kosovo run system funded from the government budget - a crucial step in assuring continuous drug supplies.

In primary health care, PSF will work with Kooperata e parë Farmaceutike e Kosovës (KFK) - a co-operative of the former state pharmacies - to establish a sustainable system. With technical assistance and training from WHO, the two organizations will secure a network of pharmacies that will operate on principles of public health rather than profit.

This network will initially continue the distribution of humanitarian drugs, but later it will function using a reimbursement system in which pharmacists will be responsible for buying their stock and invoicing the government for payment, rather than receiving actual drugs from the government.

In the hospital sector, drug management tools and systems, being developed by WHO, PSF and Mediciens sans Frontieres with local staff in Pristina and Prizren, will be rolled out to the other hospitals in spring and summer 2000. These should enable all hospitals to reliably estimate needs and ensure accountability.

At a UNMIK central level, capacity is now being built up to enable the Department of Health and Social Welfare to carry out reliable and cost-effective procurement.

Getting rid of old drugs

Accumulations of expired and useless drugs are taking up much needed space in health facilities around Kosovo. WHO and its pharmaceutical partners are starting to develop procedures to dispose these products. The approach will be to classify drugs according to how they can be disposed. The bulk of expired drugs does not, in fact, not need high temperature incineration and can be disposed of in much simpler ways, leaving only a small volume of drug requiring specialist disposal.

For further information, please contact Martin Auton or Lerim Azizi at the WHO office.

New recruit boosts regional team

The WHO pharmaceuticals project has recruited a third member of the team to improve communications and advice to the regions. Dardane Arifaj will spend most of her time in the field assisting in resolving issues of pharmaceutical supply and use in the health facilities. "We hope this will enable health professionals and NGOs to have a better understanding of the development of the pharmaceutical sector in Kosovo, as well as an easy route through which to channel their comments," says WHO pharmaceutical adviser Martin Auton.

HUMAN RIGHTS

Focus for human rights in Pristina opens

The Organization for Security and Co-operation in Europe has opened a human rights office in Pristina. Equipped with interpreters and communication equipment, it will be open on Monday, Wednesday and Friday from 9am to 12 noon and aims to provide not only individual advice and support, but also give local human rights NGOs a meeting place.

For further information, please contact OSCE

CALL FOR INFORMATION

Health Talks is a forum for health information from all sources, agencies and organizations. If you wish to disseminate or request information on any health-related subject, please contact:

Hilary Bower,
WHO Information Officer,
at the WHO office, Pristina
Office phones: + 381 38 549 216/218,
Office mobile: +381 63 406 895.
Personal mobile: + 41 79 244 6008
Email: hbower26@hotmail.com

Please provide written information, by email if possible, by the weekend before the General Health Co-ordination meeting.

REPRODUCTIVE HEALTH

Women's centre for Pejë

The International Rescue Committee has refurbished and opened a Women's 'Wellness' Centre in Pejë/Pec. Equipped to provide a venue for seminars, workshops and activities, the centre also provides psychosocial counseling and referral services as part of IRC's programme of projects in reproductive health and gender-based violence.

The latter project has just completed a successful local education campaign in the municipality designed to raise community awareness of sexual and gender based violence. "The aim of our projects in Pejë/Pec is to strengthen and increased the knowledge base and skill of local health providers, says IRC's Beverly Kohler.

IRC is also playing a key role in implementing a five day crash course in reproductive health care in the Pejë/Pec region, along with Relief International and CARE who adapted the course for Kosovo. The latter are conducting seminars in Mitrovica, Pristina and Prizren.

Each week, says Beverly Kohler, 20 health care providers, including gynaecologists, GPs, midwives, patronage nurses and hospital nurses are receiving a certificate of participation in the course which offers essential updating in the basics of safe motherhood, family planning, sexually transmitted diseases and sexual and gender-based violence.

IRC's nurse educators are also spending time with women's groups in the municipality's villages. "There are many questions about irregular menses, infertility and contraception, particularly in methods that could be concealed from their partner," notes Kohler.

PUBLIC HEALTH

DfID commits £1 million to public health

The UK’s Department for International Development is about to sign a memorandum of understanding with WHO for the Institute of Public Health committing £1 million to projects which will allow it to become the technical engine of public health policy for the Department of Health and Social Welfare. The project is the result of six weeks of intensive collaboration between IPH directors, WHO and DfID representatives in Pristina. The money will not only bring material resources but involve the recruitment of three to five public health experts to work alongside local counterparts.

Full details of the project and the future direction of the Institute of Public Health will feature in the next issue of Kosovo Health Talks.

New arrivals boost public health arena

WHO is being joined by a number of international consultants focused on public health issues. Next week, Dr Reinhard Jung-Hecker will take arrive to become WHO coordinator at the Institute of Public Health in Pristina. Canadian epidemiologist Dr Ramez Zemohkhol also arrived this week to join the Institute of Public Health for three months. In the main office Dr Agim Kotari, from the Institute of Public Health in Pejë/Pec has started work with Dr Evdokia Dardamissis to aid the Immunization Commission in implementing the 2000 to 2002 plan which targets the gradual integration of vaccination services into primary care and methods of increasing coverage. Dr Dardamissis, a specialist registrar in public health from the North West of England in Kosovo for a six week mission, is also developing a survey of primary care drug use in Kosovo aim in order to develop a rational prescribing policy and identify priority areas for action and training needs for professionals.

IMMUNIZATION

Vaccination action plans take shape

Last week the Expanded Program of Immunization (EPI) Commission drafted a final EPI Action Plan for the years 2000 to 2002, reports UNICEF spokesman Gordon Weiss. It includes policies and guidelines for the new immunization schedule, a revamped reporting system and reporting forms and revised immunization cards for facilities and individuals, designed by Institute of Public Health and UNICEF.

UNICEF has also now received cold chain equipment which will be used to completely refurbish the immunization system, says Weiss, and the agency is planning to deploy 30 vehicles for outreach immunization activities.

The EPI Commission is now preparing the detailed action plan for this year's rounds and is currently undertaking a series of regional meetings to consult on the material. These meetings are bringing together regional and municipal immunization service staff with local and international NGOs and agencies.

Support on the way for Serb village

UNICEF is helping the Kosovar Serb immunization programme in Donja Gushterica to obtain vaccines from the central Institute of Public Health after supplies from Belgrade have proved slow and unreliable in arrival. Gordon Weiss, UNICEF spokesman, says the agency is also providing emergency health kits and cold chain equipment, as well as basic equipment, such as - scales, a baby bed, an incubator, diapers, and medical instruments. to the health house which is reported to be in very poor condition.

MENTAL HEALTH

Help needed for Shtimë children

Twenty three children currently living in the Shtimë/Shtimlje Mental Institution desperately need their own home and a proper rehabilitation programme, away from the institution's main building, says WHO's Mental Health Coordinator Dr Liliana Urbina.

"These are children who are mentally and physically disabled who cannot be reintegrated into their family, mostly because they have been abandoned. We urgently need to find a solution for them because their situation, despite the best efforts of the staff and the Norwegian Red Cross, is very unsatisfactory."

Though the ideal would be to have the children in a small protected house in the community, realistically, says Dr Urbina, because half are Serb and because of the difficulty of finding trained personnel, the best solution would be to separate off an area of the Institution's large grounds and build a protected house there with a separate entrance. "This way the children could live more normally and be cared for by trained staff. It is not a large, or difficult, project but one that really would make a difference," says Dr Urbina.

For further information, please contact Dr Urbina at the WHO office

HEALTH TALKS ON THE NET

Kosovo Health Talks is also published fortnightly on the WHO/EURO website - http://par.who.dk, click contents, then enter Kosovo Health Talks in the search field for back issues - and on Relief Web: www.reliefweb.int.

Assessing patients and future plans

The main institution at Shtimë/Shtimlje has been closed to admissions since the end of the war - for space reasons but also because of the lack of a precise strategy for the hospital's future.

As part of this, the Norwegian Red Cross team are slowly carrying out assessments of the 316 patients - almost two thirds of whom are Serb - to explore which may be able to return to their families, or in the future to protected houses in the community "It's difficult to know whether the condition of some of the patients is a result of being in an institution for 30 years, whether they were born with disability or whether it has a pathological cause," says Dr Urbina. "Some may be able to live in the community or with their families, some may still need 24 hour care but there are solutions other than a hospital like protected apartments - small structures where people can live decently and can take part on rehabilitation programmes."

A few patients have already been reunited with their families, with the help of the International Committee of the Red Cross, but progress is sensitive and on a case by case basis.

Mental health brings communities together

Both Albanian and Serb doctors and nurses attended a recent mental health coordination meeting for the Mitrovica region. The aim was to discuss the future organization of mental health services in Kosovo and the principles of community-based care, and to start planning for a mental health seminar to be held on 26 February. NGOs also attended the meeting, which was considered a successful and valuable first step to better communications across the communities in mental health.

A second cross-community initiative, this time a training course on child psychiatry - is planned for the week of 14 February. Taught by French psychiatrist Dr Michel Grappe, it offers nurses an introduction to the discipline and a chance to start upgrading their skills in a discipline that has received little attention in Kosovo in the past. In the long term, it hoped that a day care centre for children affected by psychiatric and psychological disorders can be set up in the town but human resources will be key to this development.

For more information on both events, please contact Dr Marie Claire Paty, WHO Mitrovica.

VIOLENCE AND INJURY PREVENTION

Be prepared for renewed mine dangers

Thawing ice and spring rains will bring fresh dangers as hidden mines and UXOs move into what have previously been safe areas. To rekindle attention and build on last year's successful activities, the Mine Action Co-ordination Centre is running its second seminar on mine/UXO awareness education activities on Saturday 12 February.

The day will focus on mine action education planning and information tools and the support the centre can give in coordinating activities. Key topics on the agenda include the allocation of priority focus areas based on Geographic Information Service information, updates on victim information and information from UNICEF on the introduction of awareness education into schools. There will also be workshops on field-testing, monitoring and evaluation of materials.

"We strongly encourage participation by all members of the mine awareness education community," says Leonie Barnes, UNMIK mine action programme chief of public information, who adds that with the significant changeover of staff UN agencies and NGO may wish to remind staff of the regular mine awareness sessions run by UNMACC throughout Kosovo.

For more information, please contact UNMACC 038 501 597, barnes@un.org.

WHO in Kosovo

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