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WHO Kosovo Health Talks 16

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NEWS UPDATE
HUMAN RESOURCES

Cuts in health staff averted With the support of WHO, UNMIK Health has succeeded in persuading those bankrolling the reconstruction of Kosovo’s health services that there are not too many doctors, nurses and technicians working in the sector but, in fact, too few according to comparisons with other Balkan and European countries.

UNMIK health has been under heavy pressure to cut staff numbers due to a perception that not only is the total number of health personnel excessive, but unnecessary people have flocked to the sector since health became the first public service to start paying stipends. Other criticisms have been that there are too many physicians in relation to nurses and that hospitals should have no more staff than there are beds.

However, an in-depth analysis carried out by Dr Margereta Rubin shows that the Former Yugoslav Republic of Macedonia has almost twice as many doctors per 100,000 population as Kosovo and about 40% more nurses, while the European average runs at roughly 40% higher for doctors and double the number of nurses. Only Albania has fewer doctors (130 compared to 139 per 100,000). It’s also likely nurses are even more sparse on the ground in Kosovo than figures suggest as most estimates combine nursing staff with technicians.

“We may take issue with where these staff are working but we certainly can’t say there are too many,” says Dr Rubin. The figures are based on the rolls collected for the first round of stipends, she adds. “I am hoping that more doctors and nurses have come into the system over the past month because at present there is a shortage.”

Only one hospital – Mitrovica – is clearly overstaffed, says Dr Hannu Vuori, Head of UNMK Health Secretariat, and that is for political not health reasons. “I do not feel we can reduce the number of health workers without seriously jeopardising the quality of services. But there is certainly space to improve the efficiency of the use of hospital beds,“ he says.

UNMIK HEALTH

DEM 24.9 million for health

After months of having no budget for running public services, UNMIK’s civil administration has finally been allocated its 1999 budget with 24.9 million DEM of it earmarked for health services. The amount is based on the projected 75m DEM annual budget for health in the year 2000 and intended to cover salaries, heating, supplies and other running costs for September to December. With the help of the WHO policy team, each region has been allocated a slice of the budget.

For primary care, this is based on population and for secondary care on hospital bed numbers with the addition of some special weighting factors. Due to the lack of information on past service provision, however, this division involves an element of guess work, says UNMIK Health Finance Officer, Anthony Gabriel. In future, financing “should follow explicit identification of
needs, not the existing pattern of facilities and services”.

The money means that UNMIK Health now has funds to breach the gaps in clinical supplies to areas less well served by aid donations. It also means that staff stipend payments will no longer be dependent on the multi-national trust.

STIPENDS

WHO warns against reducing payments

WHO and UNMIK Health are warning against suggestions that health workers will receive at least 25% less than expected in their next 2 stipend payment, due to start in early December.

Such a move would cause extreme disappointment in the healthcare sector and severely hamper progress in re-establishing an effective health system, say the two bodies. The stipend issue has dogged both local and international health workers since August. Most health service workers have now received a first payment of between 150 and 350 DEM
depending on their position, though some are still outstanding. The amount was intended as a simple recognition for all the voluntary work carried out by health workers during the immediate return to Kosovo in June, July and August and was paid from an emergency trust fund in lieu of a budget being approved.

However, new plans understood to be under consideration by UNMIK’s treasury section suggest that the remaining stipend payments for this year will cover September/October and November/December. Since the original proposals outlined four stipend payments before the end of the year, this means health workers would receive between 25% less than expected if the August payment is considered part of this year’s budget, and 50% less if it is not.

WHO and UNMIK Health stress that the unhappiness this will cause will severely undermine progress in the health service, and both organizations are urging UNMIK paymasters to reconsider, especially since the Kosovo budget itself contains an allocation for four stipends. “If funds are truly available, we strongly recommend that every effort should be made to pay four full stipend payments from this budget,“ says Dr Dean Shuey, WHO health policy adviser.

With the next payments due to start in December, UNMIK Health and WHO are arguing the case with senior UN executives. In the meantime, however, they ask health workers to continue their vital work.

Pristina Hospital completes second payment

Over 95% of Pristina University Hospital health workers of the 2927 on the UNMIK-approved employee list were paid their second stipend by Monday this week. The initiative which used a new payment system – utilizing money vouchers distributed by heads of department and redeemable at the SDK banking facility – which streamlined the whole process and removed any queuing, was a collaborative initiative between WHO, the hospital, the UK’s Department for International Development international advisory team, local heads of department, UNMIK and SDK and demonstrates the success achievable through joint initiatives. Workers were paid 100, 200 or 300 DEM depending on their position. It is understood that DfID plan to make another ‘top-up’ payment to PUH workers in the near future.

UNMIK paymasters say payments will begin throughout Kosovo using the same system in the first week of December and health facilities who have not yet returned staff records are urged to do so to be included in the next round of stipends.

Local experts and support staff wanted

UNMIK Health is looking to recruit two Kosovo doctors to take up posts as technical experts in the secretariat as part of a drive to increase the involvement of Kosovars in the process of government in preparation for the transition from UN to local administration. Candidates must be acceptable to all political parties, as well as experts in fields of most use to the health sector.

A number of qualified and experienced support staff are also being sought for the Health Secretariat. Applicants should have previous experience with international agencies or in a business or medical environment, a good working knowledge of English and local languages and advanced computer skills. Candidates for the latter posts should send copies of their CV, graduate and post graduate degrees if available, character and employment references and a contact telephone number if
available to the WHO office, Momcilo Popovic 1, 38 000 Pristina.

HOSPITALS

Winter prospects improve

If real winter arrives tomorrow, most hospitals are prepared to face it, if not in luxury, then at least with basic conditions in place, says WHO Hospitals Coordinator Dr Margareta Rubin. However, UNMIK Health will need to move fast to get money to the regions to maintain this state of affairs since several sites only have fuel commitments for a month or so.

The past month, says Dr Rubin, has seen intense activity by hospital management teams, NGOs and UN agencies to get essentials such as heating and water in place and repairs done.

“Most started this winter with nothing, but now all hospitals, bar one, Gjilan/Gnjilane, are covered or heating for at least a month. Leaking roofs have been repaired and food secured for winter.” Most hospitals have also secured a water supply, but Gjakovë/Djakovica and Gjilan/ Gnjilane still face problems due to the lack of generators to combat the power cuts. Gjilan is
also suffering from an irregular supply of drugs and delays to repairs promised by US KFOR.

One exception to this generally more positive outlook is Pejë/Pec TB hospital which is in extremely poor condition with no prospect of repair. However since many of the 200 patients already spend weekends at home, an emergency plan has been formulated which would see TB patients who require continued hospitalization housed in a vacant department of Pejë/Pec General Hospital if temperatures drop too low, and the remainder sent home to continue treatment in the community.

Tracking specialty staff

Early reports from work underway to identify available staff in secondary care specialties suggest that the only specialties that are severely under-subscribed may be anaesthesiology and radiology, with the former most urgent since operations cannot be done without anaesthesiologists. That said, the distribution of specialty staff throughout Kosovo leaves much to be desired, says WHO Hospitals Coordinator, Dr Margareta Rubin, with consultants concentrated in Pristina and shortages in the regional hospitals. Dr Rubin also suggests that now is the time to start educating nurse anaesthetists so as to decrease
the need for medical specialists in the future.

Patients travel for treatment

A total of 305 patients (135 female, 170 male) have now been approved for treatment abroad by the international committee of the Transitional Regional Management Programme for Complex Medical and Surgical Cases (Medevac). Of the 87 who have left for treatment, the majority were suffering from complex injuries (24.6%), congenital disease of mainly cardiac
origin (33.2%) and cancer (24.2%). Other cases include cardiovascular and ophthalmological conditions.

Ten countries have received patients for treatment. These include 52 patients who went to Germany, 11 to the UK , seven to the US, five to the Czech Republic and five to Albania. Switzerland, Austria, Spain, France and Macedonia have also taken patients. So far 24 patients have returned to Kosovo. Ministries of Health in neighbouring countries have also expressed willingness to provide health care for cases from Kosovo, though not free of charge due to reluctance to further strain
their own overburdened health budgets. The International Organization for Migration (IOM) has taken responsibility for gaining visas for medical cases and to facilitate processing and establish clear procedures, IOM representatives visited the US, Swiss, Italian, British and German embassies earlier this month If you wish to propose patient for medical evacuation, referral should take place firs through the regional specialist and then through the relevant consultant at Pristina Hospital. If
you are unsure of the correct referral procedure, please contact Dr Margareta Rubin or Dr Arta Ibrani at WHO or Dr Andrea Capusan at IOM

FAMILY MEDICINE FOCUS

Fitting health policy to the people

The snow has not yet come, but it’s not hard to imagine the ride over the muddy, potholed unsealed road that a new mother and her baby from Restelica, in the southern Sar mountains of Kosovo, would have to make should they have need of the advice of family medicine specialists at the health centre at Dragash. Even on this sunny day, the 25-kilometre drive takes an hour, but when the road is churned to mud or given a blanket of snow or ice, it won’t be an attractive prospect – sick or well.

It’s this kind of scenario that’s exercising the minds of those trying to put Kosovo’s new health policy into action. After a month of consultations with local and international professionals, however, WHO and UNMIK Health staff in four out of the five regions in Kosovo are well on the way to producing recommendations on which of the 350 primary health care facilities currently existing should become the new family health centres outlined in UNMIK’s interim health policy guidelines.

The “Blue Book” as it is known, spells out a primary care system based on the family health centre concept – a system which gathers expert GPs and nurses together in a health centre and asks patients to travel to it, rather than maintaining lots of small surgeries. This, say WHO’s health system experts, is more cost-effective, reduces hospital admissions, and gives patients better care, not only because trained family practitioners and primary care nurses can deal with up to 90 per cent of the health care problems of a community, but also because gathering professionals together allows individuals to specialize in particular areas of care, such as nutrition, reproductive medicine or chronic illness. Teams can also assure 24 hour access to care. Certainly it’s the way most of Europe’s primary health care services operate.

According to the guidelines, family health centres should ideally house five doctors and 10 nurses and serve a catchment area of some 10,000 people. In practice, however, the exercise is more complex, requiring flexibility for geographic and seasonal conditions. The small practice manned by a single tired GP and a nurse in Restelica, for example, covers only 4,500, while down the road at Krushevo, another small ambulanta serves 3,000 inhabitants with a single doctor and a nurse.

Both will be cut off in winter and can’t be left with only a family medicine centre at Dragash to serve them. On the other side of Dragash, a single nurse gives injections, and little else, to a community of 1700 while anyone requiring medical attention must already travel to Dragash. Plainly simply counting heads won’t work, says Dr Erik Schouten WHO’s Public Health Adviser for the Prizren region. In the end, there will have to be a compromise between policy and people. Small ambulantas will need to be maintained in some places, but as branch surgeries staffed by medical and nursing practitioners who are an integral part
of the main health centre team, not just referral machines or injection merchants.

Along with the health staff database which is nearing completion, and curriculum for training and updating family practitioners due to be finished in January – the family health centre site plan is a crucial step in implementing the shift to primary care. It will be presented to UNMIK later this month.

WANTED!

With health policy moving practice, WHO is looking to recruit regionally-based local medical professionals to assist in the development and implementation of Kosovo’s future health services, in particularly the family medicine concept. Key skills required include: basic medical degree and post graduate qualification, fluent English and relevant experience in planning
health services at a regional or national level. Interested professionals should contact the head of mission or programmes at the WHO office.

EDUCATION AND TRAINING

Hungarian course reveals the challenge “Now I have much more understanding about how difficult it is going to be to give Kosovo a good health care system. I can see the strong discrepancy between our wishes and what will be possible, at least at the beginning.” This is Dr Ilir Q Tolaj’s verdict after two weeks study on the International Organization for Migration’s first intensive training course in Health Management and Administration. Dr Tolaj at Pristina Medical Faculty and a specialist in
Pristina University Hospital’s infectious disease clinic, was one of 14 Kosovars to take part in the course which was held at the University of Health Sciences (HIETE) in Budapest, Hungary last month.

The course covered issues such as health care systems, methods of financing and experiences of health care reform in seminars and lectures with experts such as Dr. Brian Gushulak, IOM Director of Medical Services, who closed the course with a lecture on migration-related health problems. As well as visiting several health care institutions, participants also received a 350-page textbook in English, prepared by the HIETE Institute of Public Health Medicine and based on field visit in Kosovo.

According to Dr Tolaj, studying other health care systems, including Hungary which has been through similar reforms to those suggested for Kosovo was extremely valuable, but also quite disturbing. “Transitional periods are very painful even if there has been no war and one of the things we learned from the course is that it can be difficult enough to maintain a good health service in a developed country when there is not a strong economy,” he told Health Talks. “This made it even more clear to us the challenge we face in Kosovo. “

The years between 1970 and 1980 were good ones in Kosovo, says Dr Tolaj, and many are finding it difficult to accept that it’s not possible to simply go back. “But now is the proper time to make changes. This is a dynamic time, there are big changes in every area of life, so let it also be so in health care. The course has given us the basic knowledge to start driving health care reform.”

While the first course participants now preparing theses for the final exam on 10 December, a second group of trainees, consisting of eight Kosovar, eight Albanian and four Macedonian candidates, left last week for Hungary. On completion, all 22 Kosovar health care professionals have committed to act as trainers for a post-graduate course to be set up by Pristina University medical faculty. UNMIK Health and the UK’s Department for International Development hospital management group have promised to support the freshly-trained local trainers and HIETE is working on the textbook that will be translated into Albanian.

For further information, please contact Dr Andrea Capusan, IOM medical director on 038 549 042

EQUIPMENT

Now available at the WHO and UNMIK health Offices: Interim guidance on clinical equipment procurement for health care
facilities.

Get back to basics first

Over 90 different organizations are active in donating medical equipment to Kosovo. In most cases, donations that are arriving now in the territory are based on assessments done in August. Dr Margareta Rubin, WHO hospitals coordinator stresses that UNMIK Health and WHO will not support the ordering of any equipment outside the basic list until these essential needs have been fulfilled.

SOCIAL WELFARE

1 December deadline for emergency assistance UNMIK’s Social Welfare and Labour Secretariat and the Kosovo Centres for Social Work have initiated a programme of financial aid for people who are unable to meet vital living needs. The groups defined as vulnerable who may be eligible for financial support are:

  • Elderly people 70 years and over
  • Single parent households
  • Families with one or more disabled child or adult unfit for work.

Families benefiting from the programme will receive cash to a maximum of 100 DEM a month. Individuals will receive between 10 DEM and 25 DEM a month depending on their circumstances and there is also a possibility of an additional payment of 20 DEM for host families in difficulties. One payment will be made for the months of November and December. The deadline for applications forms is 1 December Please contact the nearest UNMIK regional or municipal office for further information and application forms.

CHILD HEALTH

Future trainers look to infant wellbeing

Nineteen doctors from all over Kosovo completed a crash training of trainers course in WHO's gold standard child health programme, the Integrated Management of Childhood Illness, last week. The event was a collaboration effort between the International Medical Corps and WHO. The aim of IMCI, says WHO Maternal and Child Health Adviser, Dr Hélène Lefévre-Cholay, "is to train people to recognise the child who is in real danger and then to treat those symptoms even if they are not sure of the end diagnosis. In this crash course, we covered acute respiratory infection, diarrhoeal disease, ear and throat infections and fever. The key is not diagnosis -often when a child is sick you never quite know what the diagnosis is, but you need to know that if a child is convulsing in front of you, you know what to do and then to transfer, not wait to try and work out a diagnosis."

This knowledge will be lifesaving, particularly in Kosovo where infection is a large contributor to infant death, she adds. The course also covered communication skills which, says Dr Lefévre-Cholay, are needed not only to pass on such information to other health professionals but equally importantly to parents themselves. "For example, we would always ask a mother who has to give drugs to her child to practise in front of the doctor to make sure the information has been absorbed. So the crash course included lots of role play."

IMC are taking this course – which uses generic IMCI training materials – out to their area of responsibility (Ferizaj/Uroshevac, Lipjan/Lipljan, Viti/Vitina, Kamenica, Mitroivica, Podujeva and Kline/Klina) from next week (29 November) when local trainers will train primary healthcare staff from health houses and ambulantas For further information, please contact Dr Hélène Lefévre-Cholay at the WHO Office after 26 November.

First vaccine rounds clarify future needs

Two rapid assessments of immunization services in Kosovo coordinated by UNICEF reveal that, while much has been achieved in restarting immunisation services, much is still to be done, according to Dr Lulzim Cela, a member of the Institute of Public Health Immunization Commission. Of 140 continuous immunization service points assessed, almost half had no cold chain and 48% had no electricity while the remainder face long periods of restriction. Nearly a third of sites lacked immunization files, vehicles available to support vaccination have reduced from 23 to six and across Kosovo, doctors and nurses working in immunization services have decreased by over a third.

Many of these problems are being worked on, says Dr Cela. But most important is the move to shift the immunization system into the routine package provided by family medicine centres, and away from a separate network of staff and buildings. This would decrease the need for mobile vaccine teams, as well as increasing immunization coverage, improving practice and
raising public awareness.

For further details of the assessments, please contact UNICEF, WHO or the institute of Public Health Immunisation Commission.

Breast feeding blitz for nurses and doctors

WHO is running updating courses on breastfeeding for all maternity staff at hospitals and health houses with delivery facilities. Dates have yet to be confirmed but will be in late November and early December.

The five to six-hour course will provide an overview of the role of breast-feeding in primary and public health, outline basic information on how breast-milk is made and maintained and cover basic breast-feeding management strategy. It will also teach staff how to help mothers position and attach infants correctly.

For further details, please contact Elizabeth Hormann, WHO Lactation Consultant.

PHARMACEUTICALS

Pharmacists join primary care strategy team

State pharmacists, together with WHO, have agreed to establish an organization to guide the development and activities of state pharmacies in the drug supply system for primary health care. Four state pharmacists have been co-opted onto the UNMIK Taskforce on Drugs and Medical Supplies working group on finance and supply to add their expertise to the planning process.

Members of this working group have been visiting state pharmacies around the territory recently to discuss their role within the primary health care drug supply system and have found most of the premises in good condition, with good facilities for storage and the other normal functions of a pharmacy shop. Pharmacy staff (which includes pharmacists and pharmacy technicians) have continued to function in a professional manner despite the big reduction in the range and quantity of their stock along with other difficulties, says Dr Paul Spivey, WHO Pharmaceuticals Adviser.

Lawyers check drug import controls

Temporary regulations for the control of import, wholesale and sale of pharmaceutical products have been approved by Joint Civil Commission (Health) and are currently being processed by the UNMIK legal department. These regulations
will introduce a system of import licenses for the commercial import of pharmaceuticals Donated medicines will also require
authorisation and only be allowed into Kosovo after approval by UNMIK Health. The object is not to delay drug donations which obviously comply with the guidelines, but to apply the criteria set out in them to prevent the introduction of unsuitable or inappropriate donations, says WHO Pharmaceutical Adviser, Dr Paul Spivey.

Relief for renal patients

A long awaited shipment of haemodialysis fluids and consumables – enough to last one month -arrived in Kosovo last week from Sweden. Arranged by Project Hope, the distribution of the supplies to Pristina, Gjilan/Gnjilane and Prizren will be completed this week.

Essential drugs outline complete

Now available from UNMIK health secretariat, WHO Pristina and Regional offices: The essential drugs list for Kosovo
The UNMIK task force working group on selection and rational use has completed its work on an initial list of drugs for distribution and prescription by primary health care facilities. Pharmaciens sans Frontières will continue to distribute according to this list. The list is likely to change over time on the basis of experience and received comments.

PSF bring order to Pristina drug supplies

Pharmaciens sans Frontières have “brought order from chaos” and made a real difference to the efficiency of drug supply throughout Pristina University Hospital, according to WHO Pharmaceutical Adviser, Dr Paul Spivey. PSF have had a pharmacist on site for the past three months and have worked hard to develop the systems which have produced a far more
effective supply to the department pharmacies. The next project is the reconstruction of a huge new pharmacy department.

DISABILITY CARE

Local NGO takes the lead in rehabilitation

Kosovar NGO, HANDIKOS, has just completed two five-week training courses for staff recruited to work with the disabled via a new network of community centres and groups. Formerly known as the Association of Paraplegics and Paralyzed Children of Kosovo, HANDIKOS is identified in the UNMIK Health Policy Guidelines as an implementing partner in the development of rehabilitation services for people with disabilities and their families at the primary health care level.

The NGO has been in operation since 1994, supported by Handicap International and Oxfam, and since the return to Kosovo in July 1999 has moved rapidly to expand its previous programme. Staff are being recruited for 10 regional community centres and 25 communal groups and the aim is to identify people with disabilities, provide peer counseling and support,
teach basic exercises to parents of children with disabilities, and conduct play therapy and educational sessions for children, says Halit Ferizi, HANDIKOS president.

HANDIKOS’ 10 regional centres were identified in the policy guidelines as sites for the 9 development of community-based rehabilitation programmes, including the provision of professional physiotherapy services. To prepare for the development of these programmes and to orient the newly recruited staff, the International Centre for the Advancement of Community Based Rehabilitation (ICACBR) from Queen’s University, Canada, with Handicap International, recently ran two five-week training sessions for staff. The first took place in the Pejë/Pec Regional Centre together with personnel from the Decan/Decani, Istog/Istok and Kline/Klina communal groups, and the second, in Pristina, with 21 staff from the Pristina, Podujeva and Gllogoc regional centres and the Malisheva, Lipjan/Lipljan, Obilic and Fushe Kosova/Kosovo Polje communal groups. ICACBR plans to continue basic education in the remaining regional centres and communal groups in the
New Year.

In the meantime, says Mr Ferizi, physiotherapists from Handicap International are training HANDIKOS physio-therapy assistants employed in the communal groups and is developing a plan to provide clinical experience for recent physiotherapy graduates from the parallel secondary school system so that they will be prepared for future employment within community-based rehabilitation centres.

DENTISTRY

Looking Kosovo in the mouth

German orthodontologist Dr Walter Mautsch has arrived in Kosovo to carry out a thorough review of the current situation and its potential development. His work is funded by German Government aid agency, GTZ.

MENTAL HEALTH

Tackling counseling issues

Community mental health services, the resources in the Albanian culture, mental health and its connections with primary health care, NGO activities, the legal framework and the key points of the Strategic Plan on Mental Health in for Kosovo are the topics on the agenda for a two day seminar planned by WHO/UNICEF on 4-5 December. This workshop should be starting point for an open discussion and exchange moment between local and foreign expertise. Another key issue will be just how effective counseling actually is. Reports from hospitals suggest that there is no sign of a decrease in patients coming to neuropsychiatric wards despite the volume of psychosocial activities on going currently in some areas of Kosovo.

These activities are also not well dispersed geographically. There are, for example, at least six counselling centres in Gjakove/Djakovica and four in Pristina but none in Gjilan/Gjilane. Many activities are implemented without any connection to the existing public services which continue to have a big flow of patients and a dramatic lack of resources, says Dr Liliana
Urbina, WHO’s Mental Health Coordinator. Very little concrete support is given to these services she adds, and local professionals engaged by international NGOs are paid up to three times more than the ones who remain in the public
services working in terrible conditions.

Guidance on effective projects

Mental health projects are burgeoning in Kosovo but, says WHO Mental Health Coordinator, Dr Liliana Urbina, it is crucial that even the smallest follows certain basic guidelines in their activities. Key advice is to carry out community– oriented activities that bring human and material resources to the local network, not to take them away. “It’s important not to create parallel systems that will disappear when the active NGO does”, says Dr Urbina. The priority must not be PTSD itself. Stress related disorders are not new, and it is not ethically acceptable to create special, stigmatizing, unsustainable institutions to treat PTSD. More useful efforts can be concentrated on giving new tools to mental health, social and primary health care
workers so that they can cope with the wide spectrum of mental suffering – from stress to psychosis – within the community. ”

The public services we develop have must be able to meet all the mental health needs of the population,” says Dr Urbina, adding that assessment, research and training should be components of any larger programmes.

WOMEN’S HEALTH

Scots expert to advise on obstetrics

“Looking at how to make practices in maternity health care more relevant for current circumstances,“ is how Dr Mary Hepburn,
consultant obstetrician and gynaecologist and senior lecturer in women’s reproductive health at the University of Glasgow describes her brief for WHO in Kosovo. An expert in developing health care for “hard to reach women” and those suffering from socio-economic deprivation, Dr Hepburn will spend 10 days assessing the skills and common practices of maternity health care staff throughout the territory and looking at ways to make it more appropriate. She’ll also be looking at the training needed to back up these 10 moves. She can be contacted at the WHO Office.

PUBLIC HEALTH

Getting the message across

Health educators from all over Kosovo are half way though a two-week course in all aspects of health promotion organised by the Kosovo Institute of Public Health in Pristina with the help of the International Rescue Committee. The goal is to update participants drawn from regional institutes of public health on new methods of creating and publicizing effective health messages. Lecturers have been drawn from the local and international community and subjects range from the use of mass media and creation of materials, such as videos and radio spots to the advantage of programmes like WHO's Integrated Management of Childhood Illness for informing health promotion and ensuring consistent messages.

Traffic kills more people than epidemics Sixty people have been killed in traffic accidents since June according to the latest figures published by UNMIK Police Traffic Department with 11 killed and 15 seriously injured in Pristina alone during October.

COMMUNICABLE DISEASES

Please see pages 10 to 13 for the latest epidemiological reports. Also available at the WHO Office, “Epidemiological Situation and Public Health Action in Kosovo” – an update in the overall epidemiological status of public health by WHO consultants. Seminar spotlights disease surveillance Over 50 epidemiologists from across Kosovo will come together on the 12-15 December for a WHO training of trainers workshop on disease surveillance. The event, to be held in Prizren, is a collaboration by the Kosovo Institute of Public Health, lead by Professor Isuf Dedushaj and WHO. It aims to offer a comprehensive updating on surveillance methods, particularly for infectious diseases, but also in other areas such as mine injuries. Participants will also be trained in the use of the new surveillance system due to go into action on 1 January.

NGO COORDINATION

Legal registration moves closer

Registration will not be compulsory for NGOs but will be the route to public benefit status, or tax exemption, according to UNMIK civil administrators who anticipate the system should be ready to go into action by early next month. Registration will be needed to pass any humanitarian goods through customs and will begin in Pristina, with a mobile officer moving into the regions some weeks later when the system has been glitch-proofed. The information required will include organizational verification and a general description of activities planned for Kosovo. All data will be maintained on a public registry and be linked to the UNHCR contacts database.

Separately, UNMIK Health in collaboration with WHO plan to ask NGOs involved in the health sector to share more detailed data on their financial commitments and activities so that this can be taken into account in health service planning. As always the cooperation of NGOs will be much appreciated.

Executives elected to NGO council Mercy Corps International and Catholic Relief Services have been elected chair and deputy chair of the International NGO Council. Others members of the executive committee are Action Against Hunger, ATLAS Logistique, CARE International, Children's Aid Direct, Doctors of the World (US), Medécins du Monde (Greece), Medécins Sans Frontières, Medicos del Mundo, Pharmaciens sans Frontières and Save the Children.

The INGOC was founded in January 1999 to provide a networking and debating forum for what is now one of the largest collections of NGOs that has ever gathered together. More recently, its aim has become to provide a unified NGOs voice to UNMIK on issues of mutual concern.

The Council has been involved with developing regulations for NGO registration with UNMIK and is invited to meetings where individual NGOs do not usually have access such as the UN Inter-Agency Standing Committee. It is also charged with reviewing relationships between the NGOs, government authorities, UN agencies and other international organizations and with developing contacts with the local NGO Council formed by the OSCE.

The capacity of the council has been boosted recently by the arrival of Information Officer, Paul Currion, who says the real key to the success of the Council is "the active participation by NGOs themselves" To raise issues, attend meetings or obtain further information on the activities of the NGO Council, please contact Paul Currion at the Humanitarian Community Information Centre on 038 501 507 or 549 168.

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,
whoprishtina@hotmail.com

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

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