NEWS UPDATE
WHO KOSOVO
Funding shortfall forces cuts
WHO's regional offices are to be closed as part of a radical restructuring of the organisation's operations in Kosovo. The number of regional public health advisers will be reduced and there will be cuts also in the Mother and Child Health unit, Pharmaceuticals, Hospitals and Policy units. Total staff numbers will be reduced by more than one third.
The WHO operation in Kosovo is one of the largest in the world and it was due to downsize during this year. However the cutbacks are heavier, and have come earlier, than was first planned because of a lack of new funding.
Activities that have earmarked funding already will continue unchanged. These include the programme at the Institute of Public Health, which is funded by DFID, Mental Health (Japan), the Healthy Village programme (USAID) and primary health care.
The number of international staff falls by nine to 16 (a drop of 36 per cent) compared to the end of last year. The affected posts are due to disappear in mid-April and contracts of some remaining international staff have been shortened.
The Kosovar staff will fall by 38 per cent next month, to a total of 58, with the reduction spread evenly between professional officers and support staff.
Activities in the regions will be co-ordinated by two technical officers based at the main office in Pristina. One of these will be responsible for minority affairs. Regional public health advisers currently are based in Mitrovica, Peja/Pec, Prizren, Gjakova/Djakovica and Gjilan/Gnjilane. Some of the main activities of the Pharmaceuticals unit have already been assumed by the Kosovo Drug Regulatory Authority and KFK, but WHO will continue to advise on pharmaceuticals in hospitals and primary care.
The Japanese-funded mental health programme, which focuses on community-based mental health care, will continue to run. WHO collaborating centres in Trieste (Italy), Asturias (Spain) and Birmingham (UK) have seconded technical officers to help with implementation. The first community mental health centre was opened in Gjakova/Djakovica last week (see article below).
The Mother and Child unit is among the worst hit by the cuts, but it will be possible to resume some of its training programmes if new funding becomes available. MCH programmes include Integrated Management of Childhood Illnesses (IMCI), Essential Newborn Care and Breastfeeding, and Essential Obstetric Care.
Some other UN agencies have started to reduce their activities, but WHO's reduction is the most substantial so far. Several NGOs working in the health sector have also begun to cut back on their operations. The drop in funding for international organisations and NGOs in Kosovo coincides with the change from emergency to development operations, a redistribution of support for programmes in the Balkans region and demands for emergency support elsewhere in the world.
There has been a slow response so far this year to the UN's consolidated inter-agency appeal for 2001.
HEALTH AND SOCIAL WELFARE
Municipalities still getting ready
Most of the new municipal authorities have appointed someone to look after primary health care, but generally they are still not fully prepared for the task, DHSW co-head Bengt Stalhandske told February's general health co-ordination meeting.
He reminded the meeting that UNMIK's regional health officers "are still in place, still ready to help".
"One of the biggest questions is what will happen to political problems, to the minorities, after the handover"is completed, he said. "We are handing over a very powerful tool to the municipalities, we have to see how they will use it."
Mr Stalhandske again reminded people that the DHSW has powers to address any misuse of the system. Funds will be allocated in tranches, and a financial reserve is to be kept centrally. The budget for primary health care this year has been set at 43 million DEM. The municipalities will have to report to DHSW and a monitoring system will be established under a World Bank project.
Attitudes "need to change"
The need to provide equal access to health care for all people in Kosovo is a political issue as much as a health issue, DHSW minorities officer Lewis Kanyoko told the General Health Co-ordination meeting. "We must work towards changing people's attitudes,"he said.
While the administration is implementing Security Council resolution 1244 on Kosovo, there are specific problems that have to be addressed as a political reality. Until all patients have equal access to health facilities, "the implication is that we have to retain dual systems. This is costly,"he said.
MOTHER AND CHILD HEALTH
IMCI follow-up course underway
Two international consultants are in Kosovo to lead the follow-up course for future supervisors in the Integrated Management of Childhood Illnesses (IMCI). Bernard Borel from Switzerland and Lone Christiansen from Denmark were to join clinical and classroom sessions with Kosovar doctors in Pristina, Mitrovica, Prizren and Gjilan/Gnjilane. The follow-up is designed to reinforce the skills of doctors who have previously completed the basic IMCI course and help them to transfer these skills to clinical work in health facilities.
Other objectives are to identify problems faced by health workers in managing cases and help solve these problems, and to gather information on the performance of health workers and the conditions that influence performance.
Prizren child care specialists on course
A total of 16 doctors, almost half of them paediatricians, took part in an eight-day IMCI course in Prizren last month. Participants included four doctors from minority communities - three Bosnians and one Turk.
The training took place in the paediatric ward in Prizren hospital and in the health house.
Participants were divided into two groups of eight. Between them they saw a total of 381 patients under five. Of these 78 per cent did not need any specific treatment. This contrasts with records of treatment at the health house in the previous year, when approximately 12,000 injections were administered to about 10,000 patients (including adults).
ENVIRONMENTAL HEALTH
Sanitary inspectors in 17 municipalities
There are now 28 sanitary inspectors at work in 17 of the new municipalities, and more are to be trained on drinking water inspection in the coming weeks.
Five IPH specialists in hygiene have also received additional training.
WHO has given all municipalities with inspectors a light vehicle, bought with funding from the US State Department. These vehicles are to be used exclusively for water and sanitation inspection purposes.
Although drinking water quality control in urban areas is reliable, many challenges remain. Among these is the requirement for routine water controls to be sustainable. There is also an urgent need to improve the quality of new water supply projects, with emphasis on the development of protection zones around water sources.
WHO consultant Jean-Louis Giafferi, a hydro-geologist with extended experience in the kind of problems faced in Kosovo, is currently here to prepare recommendations for future controls.
MENTAL HEALTH
First Mental Health centre opens
The opening of the first community mental health centre, in Gjakovë/Djakovica, on 3 March marked "a big day for Kosovo", the co-head of DHSW Hannu Vuori told guests at the inauguration.
"The concept of community-based mental health is a very important part of our policy,"Dr Vuori added.
The director of the new centre, Mahmut Lila, said that the primary aim of this kind of facility was the treatment of chronic patients in their own homes.
Wolfgang Rutz, WHO Europe's regional mental health adviser, noted that 2001 is designated as the World Year of Mental Health. "There are many events in Europe to mark this year, but this is the first event of them all,"Dr Rutz said. "I hope that you will be a leader for others to follow."
He added that there were two main messages for mental health year. Firstly, that there is a big gap between "what we can do and what we are actually doing". Secondly, that "mental health causes so much suffering at great cost to society."
The centre was funded by the Japanese government and by the European Community Humanitarian Office ECHO. The Second Secretary of Japan's office in Pristina, Yukihiro Takeya, said that Japan had decided to contribute a large sum of money because of the "terrible situation faced by Kosovars during the (1999) conflict."
"This project will contribute to our wish to help patients who suffer as a result of war", he added.
Dr Vuori reminded those present that "the best way to say 'thank you' to donors is to take good care of the centre so that you can be proud of it."
The Gjakovë/Djakovica mental health working group started work in May last year. Work on the new building began in September.
MH workshop held in Pristina
The working group on mental health legal reform held a one-day workshop in Pristina at the beginning of the month to comment on the draft regulation on forced treatment before it is submitted for approval.
Francoise Simard, from UNMIK's penal and judicial system, chaired the meeting. The participants included Dr. Wolfgang Rutz, regional mental health advisor for WHO Europe, Dr. Lars Fallberg, from the WHO department for patient's rights and citizenship empowerment, Dr. Mario Reali, from the WHO collaborating centre in Trieste, Italy, Dr John Jenkins, from Birmingham, and Dr. Victor Aparicio Basauri from Asturias, Spain.
Discussions were intense and many of the workshop's recommendations are likely to be incorporated into the revised draft. Generally the document was accepted by the experts who saw it as a tool to guarantee access to care and treatment in respect of the right to freedom. A complete report of the workshop and a final draft, including the latest recommendations, is expected to be available soon.
The working group has been meeting regularly since May 2000. Its members are OSCE, SRSG's office, UNMIK Penal and Judicial system, WHO, the mental health task force, a local lawyer and a forensic psychiatrist.
PRIMARY HEALTH
Family nursing ToT course moves ahead
The family nursing training of trainer (ToT) course's teaching/learning module finished this month and the course moved on to the third module, child health.
As part of their practical training of the teaching/learning module, the ToT course participants have been preparing several health education presentations on the promotion of healthy life styles, which they have been giving in schools, day care centres and to refugee groups in different locations in Kosovo.
The students also participated in the nursing co-ordination meeting, which this time was mainly devoted to the topic of basic education for nurses, although general scenarios for nursing were discussed also.
An overview of the status of the project 'Finnish Support to the Development of Nursing in Kosovo' was presented to the steering committee on 22 February. The meeting was attended by representatives from UNMIK, the Ministry for Foreign Affairs of Finland and WHO.
On 15 February, four K-Serbian ToT course participants attended a training session in the Medical Faculty.
The next session will be held when the security situation allows. In the meanwhile, the K-Serbian nurses will have to catch up with the two modules already almost completed by the Albanian nurses. In order to facilitate the planning and implementation of the catch up training as well as the eventual joint training, an additional international nurse trainer advisor was expected to arrive in Kosovo in early March, increasing the Finnish Project's staff to eleven persons.
Nurses elect board of directors
The Kosovo Nurses Association held its first election last week and now has a board of directors. This is seen as a significant step forward in the development of the nursing profession in Kosovo. The president is Besnik Stuja and his e-mail address is bstuja@yahoo.com
NGO ACTIVITIES
CORDAID opens four new facilities
Friday 23 February was a big day for the future of health care in Gjakova/Djakovica municipality. Four new or newly-rehabilitated health facilities were opened in successive ceremonies in a single morning. The project, funded by ECHO and the Dutch organisation CORDAID, covered satellite clinics at Brekoc and Molliq, the Ereniku Family Health centre, and the main health house which is home to the family medicine centre and the family medicine training centre.
Total cost of the project was 780,000DEM, of which 78 per cent was for reconstruction and the remainder for furniture, equipment and other items (including uniforms for the total of 400 staff). ECHO paid 76 per cent of the total costs. CORDAID's total budget for all activities last year was 560,000 DEM. All the facilities have been built and equipped to WHO standards. The health house continued to be operational during its reconstruction.
CORDAID representative in Kosovo, Dr Dineke Venekamp, said that the combined openings marked the finalisation of CORDAID's infrastructure operation. The organisation continues its work with other projects.
Speaking at the opening of the health house, DHSW co-head Pleurat Sejdiu said that it was up to everyone working in health care to continue the work started by internationals and not to let people down. "We have to make this dream come true,"he said. WHO Kosovo head Erik Schouten described the opening of the four facilities as "an important step towards the development of family medicine in Kosovo."
"I want to congratulate everyone involved in this project, but particularly the people of Kosovo, for this big step forward."
More UNICEF support for Mother Theresa
UNICEF is again supporting the Medical Branch of the Mother Theresa Society, a Kosovar humanitarian organisation. UNICEF first worked with the society's medical branch in 1996. This time it plans to establish a perinatal centre to provide services to pregnant women in Pristina.
The aim of the project is to make available effective, affordable and accessible maternity services, paying special attention to the most vulnerable cases. This should contribute to UNICEF Kosovo's goal of seeing infant and maternal mortality rates drop by one third. Kosovo currently has the highest infant and maternal mortality rates in Europe. "The Mother Theresa project should help Kosovo lose this sad record,"said Ayadil Saparbekov, UNICEF's Health and Nutrition Officer in Pristina. The project is supported by a contribution from the United Kingdom's National Committee for UNICEF and the London-based newspaper Daily Telegraph.
MDM-F prepares smooth handover
Médecins du Monde France (MDM-F), which is scheduled to pull out of Kosovo at the end of June, hopes to hand over all its activities to health authorities here when it leaves.
Currently MDM-F is running four programmes in Kosovo. These are: a mobile clinic for primary care, a mobile dental care truck (see photo) to serve people without access to care, a mental health care and training programme in areas most affected by the war. and a public health education programme.
The organisation's area of reference covers seven municipalities: Pristina, Obiliq/Obilic, Fushë Kosovë/Kosovo Polje, Glogovc/ Glogovac, Malishevë/Malisevo, Suharekë/ Suva Reka and Rahovec/Orahavac.
MDM-F shares the DHSW goal of providing access to health for all in Kosovo.
MDM-F was founded in 1980 to provide medical care for the most vulnerable populations throughout the world. The organisation launched its Kosovo programme in 1998. During the war in 1999 MDM-F followed the refugee population across the border and provided primary and mental health care in the refugee camps in Montenegro, Albania and Macedonia. MDM-F came back to Kosovo with the returning refugees and helped to rebuild health structures, as well as providing primary, dental and mental health care in deprived areas. MDM-F also invested in capacity-building, with a training programme in the department of anaesthesiology and intensive care in Pristina University Hospital, and training of nurses, general practitioners and school teachers in mental health care and a public health education programme.
EDITOR'S NOTE: HEALTH TALKS IS NOW PUBLISHED MONTHLY
Health Talks is a forum for health information from all sources, agencies and organisations. If you wish to disseminate or request information on any health-related subject, please contact:
Edward Poultney, WHO Information Officer,
WHO office, Pristina
Office phones: + 381 38 549 216/218,
e-mail: poultney@excite.com
Please provide information, by e-mail if possible. Deadline for copy is 10 days after the previous issue. The General Health Co-ordination meeting is held monthly at 11am, 3rd floor Dean's Building, Pristina University Medical Faculty. The next meeting will be held on 28 March.
WHO in Kosovo
Ph +381 38 549 216/218
Fax: +381 38 549 217
Office mobile: + 377 (0) 44 120 361
Head of Mission: Dr. Erik Schouten
E-mail: who@ipko.org
Pristina region
E-mail: ismet_I@hotmail.com,
Regional Public health Adviser: Dr Ismet Lecaj
Mobile + 377 (0) 44 110 894
Prizren
Ph/fax: 038 504 604 ext.8043
Office mobile:+ 377 (0) 44 119 593
E-mail: who_prizren@hotmail.com
Regional Public Health Adviser: Dr Osman Zhuri
Gjakovë/Djakovica
Office mobile:+377 (44) 154 642
E-mail:who_gjakova@hotmail.com
RPHA: Dr.Xhevat Kurhasani
Gjilan
UNMIK Building
Ph. 038 504 604 ext. 7640
Office mobile:+377 (0) 44 127 972
E-mail: who_gjilan@hotmail.com
Regional Public Health Adviser: Dr Shpend Elezi
Pejë-Peæ
UNMIK Building
Office phone:038 504 604 ext.3116
Office mobile: +377 (0) 44 125 438
E-mail:who_peja_gjakova@hotmail.com
Public Health Adviser: Dr Xhevdet Xhemajli,
Mitrovica
UNMIK Building
Phone: 038 504 604 ext.7283
Office mobile:+377 (0) 44 176 329
E-mail: who_mitrovica@hotmail.com
RPH Adviser: Dr Mateja Kozuh Novak
Medical assistant: Qamile Ramadani.
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