Iris Hunger, Vladan Radosavljevic, Goran Belojevic and Lisa D. Rotz (eds.)NATO Science for Peace and Security Series A: Chemistry and BiologyBiopreparedness and Public Health2013Exploring Synergies10.1007/978-94-007-5273-3_6© Springer Science+Business Media Dordrecht 2013
6. Public Health in South-Eastern Europe – Exploring Synergies
(1)
WHO Country Office in Serbia, Public Health Services for South-eastern Europe, WHO Regional Office for Europe, Belgrade, Serbia
(2)
Public Health Services, WHO Regional Office for Europe, Copenhagen, Denmark
Abstract
In the past decade countries in the South-eastern Europe Health Network (SEEHN) have been making big strides to reform their health systems. The SEEHN has been providing a platform to share experiences and opening doors to resources, partnerships, technical capacity and political commitment. The ability of health systems to prevent, react, mitigate and recover from emergencies and crises is a visible indicator for the functionality of the health systems. In some of the health systems in the SEEHN there are still gaps that do not allow for a smooth and a seamless ability to respond to such demanding needs. Sometimes, parts of the populations are not accessible to the health services, and in many the public health services do not have sufficient finances and capacity to carry their tasks. Potential synergies between public health services and other arms of the health systems and beyond should be strengthened in SEEHN Member States. The WHO agenda for public health, health system strengthening and Health in All Policies continue to bring together the know-how, the ideology, partnerships, resource generation and the platform for subsequent policy development and implementation.
6.1 Background
In the period before 1990 the public health services in South-eastern Europe (SEE) were organized largely according to the highly centralized models (e.g. Semashko Model). Accordingly, the Public Health Institutes had to fulfill the following tasks: control of communicable diseases; sanitary-hygienic inspections and overall control of suspected hazards and health education. Typically, each Public Health Institute (PHI) comprised the following units: environmental health; occupational health; nutrition and food hygiene; child and adolescent health; and communicable disease control (e.g. epidemiology and microbiology).
At the turn of the 1990s, with the break-up of Yugoslavia and the turmoil that lasted more than a decade, the countries in the SEE were faced with a stark reality: economic deterioration, political instability, social turmoil and stagnation. The conflict led to a high number of internally displaced people (IDPs), refugees, and a vast migration among the professionals. The socio-economic gaps and poverty rates increased. Soon after the crisis, the rapid shift from a planned to a market economy resulted in health systems reforms that many times left the public health services (PHS) in the margins of the health and social systems, without the support needed to implement their functions.
In September 2000, representatives from 189 countries adopted the Millennium Development Goals (MDGs), a series of time-limited commitments to reduce poverty and promote human development. At the heart of these commitments were the goals to tackle urgent public health issues by the target date of 2015. The challenges for SEE Member States to not only restore their public health systems to the pre-1990s situation, but rather to rapidly develop health systems that would match their needs have been recognized by the WHO European Region.
6.2 WHO Support to SEE During the Decade of Turmoil
WHO coordinated health activities and provided technical assistance to the SEE countries during the decade of turmoil. It ensured an orientation inline with the national health policies, health reform trends and international standards. WHO implemented humanitarian programmes in the former Yugoslavia; carried out needs monitoring; advocacy with donors; assistance to the most vulnerable; linking humanitarian programmes with the much needed humanitarian assistance and contributed to the UN Consolidated Appeals (CAPs). At that time, a bottom-up approach was used through institutional, social grass root partnerships between institutions and civil societies.
Following are some examples: in the UN Administered Province of Kosovo, WHO contributed to the rehabilitation of the health system in cooperation with the UN Mission to Kosovo (UNMIK), developed health policy guidelines with coordination with organizations working in the health arena, especially those in primary and public health services, including disease control, environmental health, community-based mental health programmes and support to mother and child health services. WHO facilitated the accessibility of refugees to health services and provided technical support to the Ministry of Health of the Former Yugoslav Republic of Macedonia. In Croatia, local authorities – assisted by WHO – established surveillance systems that were valuable for planning interventions. Using the ATLAS, the WHO worked with the authorities in Bosnia and Herzegovina to engage in mental health and the elderly. The PRINT Project is an example of an action directed at populations hit by the consequences of war and for the repatriation and reinsertion of refugees and displaced populations.
During that period, partners and WHO worked in SEE to support the peace process and renewal of social development; to allow communities to take an active part in the rehabilitation process and peaceful coexistence and solidarity; and to promote solidarity for the most vulnerable groups. In this regard a special attention was given to IDPs, refugees and returnees, people who suffered from post-traumatic stress disorder and mental health diseases, and the disabled, wounded and injured.
6.3 SEE Health Network
In 1999, the international community established the Stability Pact for SEE as a conflict-prevention and reconstruction process in the region. In 2001, a health component, SEE Health Network (SEEHN), was added to the Pact’s Social Cohesion Initiative, to bring people together across borders to improve health in the whole region [5]. SEEHN has received continuous political, technical and financial support from 11 partner countries (Belgium, France, Greece, Hungary, Italy, Netherlands, Norway, Slovenia, Sweden, Switzerland and the United Kingdom) and five international organizations.
SEEHN is a political and institutional forum set up by the governments of Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, the Republic of Moldova, Romania, Serbia, and the Former Yugoslav Republic of Macedonia to promote peace, reconciliation and health in the region. WHO Regional Office for Europe has been lending technical support to SEEHN’s various health projects, after having supplied its secretariat, along with the Council of Europe, from 2001 to 2012.
On 1 January 2010, the SEEHN took over ownership over the regional cooperation for health and development under the auspices of the Regional Cooperation Council (RCC) and the SEE Regional Cooperation Process. RCC’s main purpose is to provide leadership and to sustain ownership by the nine countries of regional cooperation and the concerted health development action launched in 2001 with the Dubrovnik Pledge [1] maintained through the 2005 Skopje Pledge [2], the 2009 Memorandum of Understanding, and the 2011 Banja Luka Pledge [3].
For more than a decade, SEEHN has been the undisputed vehicle of health development in the areas of mental health, communicable diseases, food safety and nutrition, blood safety, tobacco control, information systems, maternal and neonatal health, public health services and health systems.
The achievements of the network can be categorized:
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1.
Contribution to the peace building and stabilization process – through creating a wide network of experts at all levels as well as of political representatives:
Over 250 people are contributing to the cooperation.
Partnerships with several political and international organizations including the European Union, Regional Cooperation Council, Northern Dimension Partnership for Public Health and Social Well-Being.
2.
Development, improvement and alignment of health policies and legislation with WHO conventions and regulation and European legislation, including national strategies and work-plans:
Support to the implementation of the IHRs, surveillance of communicable diseases.
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