____________________________________________________________________________ Kosovo Health Master Plan 70597 REPORT TO Government of Kosovo – World Bank Health Sector Master Planning Project 2. DATA REPORT Prepared by Leone Coper Andrew Parkes June 2008 Report 2: Data ______________________________________________________________________________________ 1 ____________________________________________________________________________ Kosovo Health Master Plan Acknowledgements Developing a national Master Plan is a very intensive and intrusive process and involves many interviews with the personnel concerned. The authors wish to express their gratitude for the time, effort and support which has been enthusiastically devoted to this task by the Deputy Health Minister Dr Mybera Mustafa and MSH Permanent Secretary Ilir Rrecej and the many MSH and Municipal staff interviewed at the Ministry of Health, the Municipalities and individual facilities. We also thank Dr Curr Gjocaj for his assistance in arranging visits and establishing the Working Group for the Project; and Project local consultants Dr Dafina Ademi and Dr Valton Saiti for their knowledgeable input and enthusiasm. Report 2: Data ______________________________________________________________________________________ 2 ____________________________________________________________________________ Kosovo Health Master Plan Table of Contents ACRONYMS ..................................................................................................................................6 EXECUTIVE SUMMARY ................................................................................................................7 Key findings ........................................................................................................................................ 7 1. INTRODUCTION .......................................................................................................... 13 Background....................................................................................................................................... 13 Objectives of the Master Plan Project ................................................................................................ 13 2. DATA GATHERING ACTIVITIES ................................................................................. 15 Range of information sought ............................................................................................................. 15 Data Gaps and Issues....................................................................................................................... 19 3. THE CURRENT NETWORK ......................................................................................... 21 Secondary and Tertiary Care............................................................................................................. 21 Primary Care..................................................................................................................................... 21 4. HEALTH CONCERNS .................................................................................................... 23 Reasons for Seeking Primary Health Care ........................................................................................ 23 Number of insulin dependent diabetics & haemodialysis patients....................................................... 26 Reasons for seeking Outpatient care at QKUK .................................................................................. 27 Reason for Admission - Secondary Care ........................................................................................... 28 Secondary + Tertiary Care - some QKUK departments...................................................................... 29 5. FINDINGS – Infrastructure .......................................................................................... 34 Population and population movements .............................................................................................. 34 Capital investment............................................................................................................................. 36 Assessing suitability as a health facility ............................................................................................. 37 Heating, cooling, and generators ....................................................................................................... 37 Drains and water ............................................................................................................................... 38 Cleaning and maintenance of health facilities .................................................................................... 38 Structures for monitoring health quality.............................................................................................. 39 Private Sector issues ........................................................................................................................ 40 6. FINDINGS –– Activities .................................................................................................. 41 Primary health care services ............................................................................................................. 41 Maternity beds .................................................................................................................................. 44 Regional Hospital statistics by department ........................................................................................ 45 Health Information System ................................................................................................................ 50 Report 2: Data ______________________________________________________________________________________ 3 ____________________________________________________________________________ Kosovo Health Master Plan 7. FINDINGS - Resources ................................................................................................ 51 Budgeting ......................................................................................................................................... 51 Procurement ..................................................................................................................................... 52 Hospital department structure............................................................................................................ 53 Hospital beds and staffing ................................................................................................................. 54 Hospital average bed occupancy....................................................................................................... 56 Primary Health Care Staff.................................................................................................................. 58 Numbers and types of unemployed health workers............................................................................ 61 Pharmaceuticals ............................................................................................................................... 63 Equipment......................................................................................................................................... 65 Emergency Vehicles ......................................................................................................................... 67 8. THE CURRENT NETWORK BY MUNICIPALITY ......................................................... 70 8.1 Decan ................................................................................................................................... 70 8.2 Dragash .................................................................................................................................. 71 8.3 Ferizaj ..................................................................................................................................... 72 8.4 Fushe Kosove ......................................................................................................................... 73 8.5 Gjakove .................................................................................................................................. 74 8.6 Gjilan ...................................................................................................................................... 75 8.7 Gllogoc (Drenas) .................................................................................................................... 76 8.8 Hani I Elezit ............................................................................................................................. 77 8.9 Istog ........................................................................................................................................ 78 8.10 Junik ...................................................................................................................................... 79 8.11 Kacanik .................................................................................................................................. 79 8.12 Kamenice .............................................................................................................................. 80 8.13 Kline ...................................................................................................................................... 81 8.14 Lipjan .................................................................................................................................... 82 8.15 Malisheve .............................................................................................................................. 82 8.16 Mamushe .............................................................................................................................. 83 8.17 Mitrovice South....................................................................................................................... 83 8.18 Novo Berde ............................................................................................................................ 84 8.19 Obiliq ...................................................................................................................................... 85 8.20 Peje....................................................................................................................................... 86 8.21 Podujeve ............................................................................................................................... 86 8.22 Prishtine ................................................................................................................................. 87 8.23 Prizren................................................................................................................................... 90 Report 2: Data ______________________________________________________________________________________ 4 ____________________________________________________________________________ Kosovo Health Master Plan 8.24 Rahovec ................................................................................................................................ 91 8.25 Shtime ................................................................................................................................... 92 8.26 Skenderaj .............................................................................................................................. 93 8.27 Shterpce ................................................................................................................................ 94 8.28 Suha Reke ............................................................................................................................ 95 8.29 Viti ......................................................................................................................................... 96 8.30 Vushtrri.................................................................................................................................. 96 9. NEXT STEPS ................................................................................................................ 98 1 Continue gathering information .................................................................................................... 98 2 Expert Working Groups and Workshop ........................................................................................ 98 3 Present GIS data to the Working Groups ..................................................................................... 98 4 Prepare several alternative network options for discussion .......................................................... 98 5 Develop Implementation Plan for preferred network..................................................................... 98 6 Prepare Capital Investment priority list......................................................................................... 99 7 Monitoring and Evaluation Plan ................................................................................................... 99 Appendix I – People Interviewed During Data Collection ....................................................... 100 Appendix II. Health care facilities in Kosovo ......................................................................... 108 Report 2: Data ______________________________________________________________________________________ 5 ____________________________________________________________________________ Kosovo Health Master Plan ACRONYMS ABO Average Bed Occupancy ACSC Ambulatory Care Sensitive Conditions ALOS Average Length of Stay (in hospital) AMF Ambulanca or punkt CCHF Crimea-Congo hemorrhagic fever EDL Essential Drugs List FMC Family Medicine Centre G&S Goods and Services GIS Geographic Information System H&SW Health and Social Welfare HIS Health Information System HFRS Hemorrhagic Fever with Renal Syndrome ICD International Classification of Diseases ICU Intensive Care Unit IDP Internally displaced people IPH Institute of Public Health KA People using the Kosovo health system KS People in Kosovo using the Serbian health system LGF Local Government Financing MEF Ministry of Economy and Finance MFMC Main Family Medicine Centre MSH Ministry of Health NIPH National Institute of Public Health PHC Primary Health Care QKMF Main Family Medicine Centre QKUK Prishtine University Clinical Centre QMF Family Medicine Centre WHO World Health Organisation Report 2: Data ______________________________________________________________________________________ 6 ____________________________________________________________________________ Kosovo Health Master Plan EXECUTIVE SUMMARY This Report presents data gathered during the conducting of interviews with around 450 people, visits to nearly 130 facilities, departments, and municipal Health & Social Welfare sections, in 31 municipalities, and subsequent data analysis. Semi structured interviews were conducted with the Director of Health & Social Welfare and other municipality staff in each of these municipalities, and observations and semi structured interviews with Directors and staff were conducted in each facility. Prior to the visits, requests for detailed data in specific areas were provided to municipalities (14 areas of data); hospitals (53 areas); and main family medicine centres (24 areas). The facility interviews and observations were structured around 40 areas which covered the physical structure of the facility and its suitability for its purpose; the services provided, and how they are provided; and the resources, both material and human, available to provide these services. The interviews with municipalities were structured around 20 questions covering the main health concerns in the municipality and how health and health management is structured. Brief consumer surveys are being conducted which concentrate on access and areas of concern through 8 questions. The database resulting from these activities will also be available to allow more detailed study. It should be noted that this Report relies on data gathered from visits, research and interviews, and documents provided. As in all countries, people collect data in the same area for different reasons, and so figures inevitably vary, depending on the data source, especially as there is no unified collection system for all the types of data we have gathered. Where figures in this Report differ significantly enough between sources to potentially impact on planning and network decisions, this is mentioned. KEY FINDINGS The following are the key findings that will be taken into account when designing the Master Plan for Kosovo’s Health Sector. Report 2: Data ______________________________________________________________________________________ 7 ____________________________________________________________________________ Kosovo Health Master Plan 1. Population and population movements. There is discrepancy between the various sources of current population estimates, reflecting the well acknowledged need for a population census. The vast majority of municipalities visited reported that the birth rate has reduced dramatically and that they have a relatively young population which is tending to move towards the urban centers. 2. Services per population. There is consistency in a number of parameters regarding the number of services for the population. The number of hospitals tends to be low compared to other countries (0.5/100,0000),1 as are the number of primary care doctors (49/100,000), primary care nurses (138/100,000), acute care hospital beds (177/100,000), however, as in many countries, there are factors in Kosovo’s health system that mandate caution in making comparisons. 3. Low Bed Occupancy. Despite the comparatively low total number of hospital beds, the average percent of time that any one bed has a patient in it, especially in regional hospitals, is relatively low (around 57%). Again caution is needed in making comparisons. 4. Work load. In regards to work load, figures are approximate, although there is consistency across the figures available. The average number of patients seen by a doctor per day in a main family health center is about 20, with a range of 10-30. In the smaller facilities the numbers per day tend to be around 10-15. The workload of nurses is considerably less, around 5-10 patients a day. These figures are low in comparison with other countries. 5. Guidelines. Throughout Kosovo there is ample evidence of dedicated health professionals performing good quality services. Training bodies for both doctors and nurses have prepared protocols and guidelines for care, and a primary care project is currently preparing some additional protocols. There is only limited evidence however of effective implementation of clinical guidelines or protocols. 6. Monitoring of quality. There is a mandated structure in place to enable the Ministry of Health, municipalities, and various groups and committees, to monitor quality of care. The effectiveness of these programs, without a comprehensive data collection and formal performance monitoring program, is mostly questionable. It appears the monitoring in reality is more focused on processes, disciplinary measures, attendance, and 1 Numbers throughout are based on a population estimate of 2.2million Report 2: Data ______________________________________________________________________________________ 8 ____________________________________________________________________________ Kosovo Health Master Plan complaints, rather than on quality and performance improvement, other than in a few facilities. 7. Essential Drugs. The lack of drugs supplied from the Essentials Drugs List was reported to be a problem in all facilities at all levels of care. In 12 facilities monitored, monthly supplies were between 8% and 54% of the drugs ordered over the last 6 months. There is variation month by month. Other frequent complaints regarding medication supply were that supplies were delivered that had not been ordered, or were close to the expiry date. Some reported that there has been better supply in the last few months (around 50% of orders in some facilities). It will also be of concern as basic medications become more available, that pharmaceutical services are practically nonexistent. No pharmacists are employed in public primary care facilities, where wise medication use can be most easily influenced, and virtually no pharmacists in higher levels of care. 8. The lack of emergency drugs is another disturbing aspect of the general drug supply problems. Random checks were undertaken during the facility interviews to identify the availability on that day of a basic range of 14 emergency drugs supplied by the Ministry of Health. The Main Family Medicine Centers had an average of 6.8 of the 14 selected emergency drugs, with the range being between 3 and 13, and hospitals surveyed had a range between 7 and 11 of the 14 drugs. Facilities with larger ranges had mostly topped up the Ministry-supplied drugs from municipal funds. The Prishtine City Emergency Center is better supplied in this regard, with 13 of the 14 selected drugs being present on the day. Facilities 9. Emergency service vehicles. It is clear that the number and condition of auto-ambulances are also inadequate for emergency services. Of 100 vehicles identified during site visits only 47 were operational. These were from a very large variety of manufacturers, and lack of maintenance or inability to acquire, or pay for, spare parts or servicing was stated as being the usual reason for non operational vehicles. A number of donated vehicles were unable to be registered due to lack of documentation. Few auto ambulances could be regarded as fully equipped to international standards as an emergency health service vehicle. 10. Location and type of emergency facilities. The structure of emergency services will be considered as part of the Master Plan. There is generally a lack of equipment, supplies and training suitable for providing emergency services at the primary health care level. There needs to be a clear differentiation between the care that should be provided through 24hr primary care facilities and the hospital emergency departments. There is Report 2: Data ______________________________________________________________________________________ 9 ____________________________________________________________________________ Kosovo Health Master Plan also an issue with regard to the closely located Prishtina University Hospital Emergency Department and the City Emergency Center, a facility that is much newer and better equipped and is under used. 11. Laboratory. All the Main Family Medicine Centres have some capability with regard to laboratory services, most of the equipment being donated and from quite a wide variety of manufacturers. There are many examples of malfunctioning equipment where replacement parts are either unavailable or too expensive. In a number of examples new equipment has never been used because of the price of reagents or due to a lack of appropriately skilled staff. Laboratory equipment in the regional hospitals and the Prishtina University Center, where it would be expected that test volumes would be higher, do not consistently have higher volume equipment. A core group of staff has been trained in maintenance and servicing through a World Health Organisation initiative, however facilities whose staff did not receive training are now facing the need to find funds to pay the facilities with trained staff which are now contracting out these staff. 12. Imaging services are in a similar position. Much of the equipment is donated, with a variety of manufacturers. The diversity of equipment suggests there is no consistent strategy regarding what services should be provided in primary care, and therefore what equipment is required. There is a CT scanner in QKMF Kline for example, (although it is not functional due to inappropriate storage). There are three CT scanners at the Prishtina University Center, however the only one that is reasonably new and capable of being fully operational is currently non operational due to software issues. 13. Renal dialysis has clearly been one priority in establishing quality health services, and is generally in reasonable shape (apart from some lack of isolation of patients and materials which has probably led to cross infections). Municipalities also invest a large proportion of their goods and services budget transporting dialysis patients and may rely on donations to be able to provide the service. Dialysis is a procedure prone to complications, and the cleanliness of the surrounding environment and equipment maintenance is crucial. The largest center for dialysis, at Prishtina University Center, is located on the 5th floor of building that has inadequate elevators. There are also indications of infrastructure issues that will inevitably be resulting in cleanliness and infection control issues. 14. Secondary care infrastructure. Of the 36 hospital departments that were inspected during the site visits, 7 were in reasonably good overall condition, with the remainder requiring various degrees of renovation to raise them to Report 2: Data ______________________________________________________________________________________ 10 ____________________________________________________________________________ Kosovo Health Master Plan a reasonable standard. There were several situations, including some clinics at the Prishtina University Center, where the condition is so poor that it is unlikely that renovation would be a desirable or cost effective solution. Attending to maintenance and renovation should in general be a much higher priority at this stage than investing in new buildings, especially when a proposal is not accompanied by an in depth needs analysis by independent sources. 15. Primary care infrastructure. A total of 42 primary care buildings were identified and inspected. About 30% were in reasonable or good condition, even if not necessarily built to health care facility standards, while the remainder required renovation. While over 50% had reasonably effective heating most of the other parameters, such as seamless floors and effective clinical waste management, scored much lower, typically only about 20- 30%. Again maintenance and renovation is a much higher priority than new construction, except in a very few cases. 16. Human resources and the private sector. It appears that there are high numbers of unemployed health workers in the municipalities, particularly nurses. A few areas lack doctors since transport coverage incentives are no longer paid. The salaries are relatively low (physicians for example receive 247 euro/month). This is causing all health workers who able to, to also work in the private sector. It was clear during the site visits that most doctors establish their own, mainly solo, private practices close to the hospital or in their home. Only in a very few municipalities do the private health services add anything to the total range of health services available there. 17. Maternity services. Thirteen main family health centers have well established maternity units, with a total of 143 beds. There is clearly an issue with the role of these facilities as the numbers of staff have reduced over time, especially with regard to a lack of 24 hour gynecologist availability, and this has caused facilities to restrict their intake. This will also be addressed specifically in the Master Plan. 18. Financial. Procurement procedures were often mentioned during the interviews as a significant issue. Maintenance of emergency vehicles was specifically mentioned as being problematic as often there were not enough companies tendering to service a variety of vehicles from a variety of manufacturers, to satisfy legal procurement requirements, thus halting the process. Hospital managers feel they have at least some ability to manage their budget, however this is not the case with primary health care managers, whose budget is mainly managed by the municipality financial Report 2: Data ______________________________________________________________________________________ 11 ____________________________________________________________________________ Kosovo Health Master Plan areas, and it is commonly viewed that their lack of understanding of health needs also leads to unsatisfactory procurement. 19. Medical records and health information systems. The most common system in place is the National Institute of Public Health reporting system. A number of facilities however indicated that they have ceased using the system for a variety of reasons, with corruption of data being a common complaint, and the system not meeting clinical and administrative needs, another. Facilities also complain that they do not receive feedback when they do submit their data. Some facilities are involved in a Luxembourg Government-supported project which allows a more physician focused patient record to be created, and this project is currently being expanded. A World Bank project is expanding the DataGuard system into 3 project sites. Coordination with Kosovo-wide strategies for health information is vital if such activities are to contribute to improved collection of health information generally. 20. Readiness for accreditation. The site visits and interviews included a number of questions and observations that are often used in accreditation assessment internationally. It was clear during the site visits that, even though some facilities were closer than others, none of the facilities visited would be assessed as able to be accredited, if international standards are used. Report 2: Data ______________________________________________________________________________________ 12 ____________________________________________________________________________ Kosovo Health Master Plan 1. INTRODUCTION This Data Report is the second formal Report prepared for the Kosovo Master Plan Project. It is based on research undertaken in Kosovo during April, May and June 2008, and on various papers provided by local consultants and stakeholders. The intent of the Report is to present all relevant data available which can be used as a basis for recommendations regarding the MasterPlan for Kosovo’s Health System. BACKGROUND The Kosovo Strategic Development Plan and other analytical work identified a need for information and analysis to strengthen evidence-based decision making in health planning and capital investment, to manage scarce resources and use them more efficiently. The Health Law 2004/4 relies on the existence of a Network Plan of public healthcare institutions for the establishment of institutions to provide healthcare, including their number and capacity. Currently, the public sector includes the Prishtina University Clinical Center (QKUK), 10 regional or city hospitals, a number of specialized facilities and many primary health care centers. The lack of a Kosovo Master Plan based on population needs, which can be used to govern the direction and timing of capital investments in all levels of care, is resulting in inefficiency in the system. The lack of such as plan also encourages each facility to try to develop a full range of services, which may not be necessary for, or supportive of, best care. OBJECTIVES OF THE MASTER PLAN PROJECT The Master Plan Project will operate for the remainder of 2008 and will produce the following objectives: To support Kosovo in its plan to restructure and rationalize the public health sector, the overarching objective of the consultancy is to develop, in collaboration with the Ministry of Health (MSH), a Masterplan / strategy for restructuring health facilities in the public sector including PHC centers, hospitals and the Prishtina medical center. The Masterplan/strategy provides a long-term vision with targets for an efficient, sustainable and equitable health sector; and encompasses networks and development plans to guide investment and restructuring of health facilities. Report 2: Data ______________________________________________________________________________________ 13 ____________________________________________________________________________ Kosovo Health Master Plan The Masterplan/strategy will take into account overall service affordability within the limited resource envelop available for the health sector and the Government goal to create a sustainable and more efficient public sector while improving equitable access to care through a network of health facilities that ensures a continuum of care and efficiency-enhancing treatment practice. It will consider future changes in demand for care given the changing treatment patterns as well as demographics (aging population) and morbidity changes. Report 2: Data ______________________________________________________________________________________ 14 ____________________________________________________________________________ Kosovo Health Master Plan 2. DATA GATHERING ACTIVITIES To obtain an insight into the overall situation with regard to the Kosovo healthcare situation, the Consultants undertook various research activities aimed at obtaining information from a broad variety of sources including the following:  Interviews with 35 staff of Government departments including the Ministry of Health, National Institute of Public Health, Ministry of Economy & Financing, and Ministry of Transport  Site visits to all departments and units of the Prishtina University Clinical Center, five Regional Hospitals; three city hospitals; the tertiary dental facility; and the Integrated Mental Health Centre, during which assessments were made of departments in terms of staffing, services, resources and quality, as well as an assessment of the condition of each of the main buildings.  Site visits to 43 primary health care facilities including main family medicine centres, maternity units, family medicine centres, punkts, community mental health centres and TB units, during which assessments were made of each functional area in terms of services, staffing, resources and quality, as well as the condition of the buildings  Interviews with more than 450 primary, secondary and tertiary care health workers and consumers  Interviews with 30 Municipality Health & Social Services Directorates  Interviews with 7 relevant international agencies with related projects  Analysis of available data from the National Institute of Public Health (NIPH) and other sources. Included in the more than 450 people interviewed are those listed in Appendix I. RANGE OF INFORMATION SOUGHT The data requests provided to municipalities and health facilities prior to interview visits sought specific information which could involve extracting data from the health information system or other facility records. The interviews allowed more in depth exploration of specific areas and ensured that local issues and interests could be highlighted and discussed. Observations of the operations and environments of departments throughout each facility allowed Report 2: Data ______________________________________________________________________________________ 15 ____________________________________________________________________________ Kosovo Health Master Plan us to gather specific data of interest, including through additional interviews with medical staff. Areas covered in data requests and interviews included the following. 1. Municipality A. Data Request:  Estimated current population of Municipality, by settlements  Number of health care facilities by type and location  Numbers and type of medical and non medical staff in primary health care facilities  Income, including details of requested and received health budget from MEF and Municipality B. Interviews:  Local considerations with respect to health care including geography, social and health conditions  Number and type health workers employed and any unemployed health workers  Gaps in regard to staffing of health facilities  Budgeting processes and any issues, including procurement  Monitoring of quality of health services  Gaps in health services  Wastage and inefficiencies in health sector 2. Primary health care facility A. Data Request:  Population catchment area  Number of medical and non medical staff by type  Numbers and types of visits and services, patients per year, and common diagnoses  Number of patients referred to higher level of care  Numbers of patients seen/doctor Report 2: Data ______________________________________________________________________________________ 16 ____________________________________________________________________________ Kosovo Health Master Plan  Services/nurse  Numbers of emergency patients  Number of imaging services and patients  Number of laboratory services and patients  Number of types of medications in stock  Average medications prescribed/patient  Equipment inventory B. Interviews:  Population catchment details  Significant local geographic, economic and health circumstances  State of buildings and their functionality as a health facility  Hospitals refer to and access times  Interactions with private sector  Staff hours, service load, training, training needs, motivation and staffing gaps  Details of facility services including provision of legislated services and services gaps  Ambulance services including number of vehicles and transport load  Quality improvement activities  Medical records and health information systems  Current and proposed projects  Review of emergency area including emergency drug sampling  Review of XRay and laboratory areas  Pharmacy service including availability of EDL generally 3. Hospitals A. Data Request:  Layout of buildings including floor space and size of hospital compound  Organisation Chart and Strategic Plan Report 2: Data ______________________________________________________________________________________ 17 ____________________________________________________________________________ Kosovo Health Master Plan  Staff: numbers and type of medical and non medical staff for total hospital and by department:  All admissions for most recent year, by department, by ICD 10 code  Numbers of visits, patients, and conditions, at each outpatient clinic, by ICD 10 code  Number of referrals from feeder facilities  Number of imaging services and patients  Number of laboratory services and patients  Average length of stay for normal delivery  Number of renal dialysis patients and sessions  For (1) the hospital as a whole, and also (2) separated by department: o Number and type of day surgeries o Annual post operative infection rate o Infections secondary to medical care/year o Number readmissions within 24 hours after discharge/year o Number readmissions within 28 days after discharge/year o Number patients transferred to other facility/year o Number of treatment protocols for major conditions o Number of transfusions and type  Number of types of medications regularly kept in stock  Number of medications dispensed and average number of medications/patient on discharge  Equipment inventory – type; manufacturer/model; location; age; if maintained; if working B. Interviews:  Catchment area and population served  State of hospital buildings and functionality as a health facility  Departments available and services referred  Services and department gaps  Staff assessment  Management structure and activities including monitoring  Emergency services including ambulance and transport services Report 2: Data ______________________________________________________________________________________ 18 ____________________________________________________________________________ Kosovo Health Master Plan  Current and proposed projects  Assessment of departments of interest DATA GAPS AND ISSUES Regarding the data sought, a number of fields were not available, or some caution is needed in interpreting the figures. These are described below.  Population No population census has been conducted in Kosovo since 1981. Municipalities attempt to estimate their population through various means, including using voter registrations and school enrolments. Some municipalities were able to provide settlement population estimates. Population data will be clarified to the extent possible by the GIS consultant.  Population catchment area Some data is available. Most facilities had originally started registration of patients, but had ceased due to lack of supply of health cards, or issues with application or enforcement.  Numbers and type of medical and non medical staff Staff numbers are a snapshot in time. They also vary depending on the source and their reason and method for data collection, time lag for updating, and whether full time equivalents or total people are counted. Figures obtained are in general accurate enough though for the purposes of Master Planning, with any areas not so, being further investigated to the extent possible. Resident doctors are sometimes recorded and sometimes not, as they are paid through a different budget.  Health budget Again there are some variations depending on the Municipality’s approach.  Wastage and inefficiencies in health sector Report 2: Data ______________________________________________________________________________________ 19 ____________________________________________________________________________ Kosovo Health Master Plan Wastage and inefficiency is obvious, but awareness of where savings could be made was not high among the vast majority of those interviewed, being too overwhelmed day to day by what was not available. A few mentioned an excess of non medical workers.  Visits, services, patients, common diagnoses, referrals There is not a common data set, making comparisons difficult, however enough data is available to assist Master Planning. Although facilities often know the number of visits and types of services provided, and sometimes a log of patients is maintained, there is often no longitudinal patient record, so patients may be counted multiple times in these figures. Most record 1st + 2nd visit for the same episode as the second visit is not levied for a copayment. Frequently facilities only record either the services or the patients but not both, and it is sometimes not clear which is being presented.  Medications and Pharmacy Service Inventories are available for stock at each facility, with centralized inventories at each Main Family Medicine Centre (QKMF). Facilities also record medications ordered and medications received, allowing gaps to be readily calculated. Facilities do not generally have medication records for patients. Apart from keeping inventory and handing out medications after entry into the log book, there are no pharmacy services provided.  Equipment inventory Although equipment inventory management software is available, at least in hospitals, record keeping varies considerably, however enough data is available to give a picture, and we have been able to record laboratory and radiology equipment in most facilities, during our observation visits.  Admissions for most recent year, by department, by ICD 10 code Availability of records vary, as does the administrative organization of functions.  Infection rates and readmissions Most departments do not routinely collect this type of data, used in many countries as quality measures. Report 2: Data ______________________________________________________________________________________ 20 ____________________________________________________________________________ Kosovo Health Master Plan 3. THE CURRENT NETWORK The current healthcare network in Kosovo includes the following: SECONDARY AND TERTIARY CARE  1 Tertiary care Hospital, the Prishtina University Center (QKUK), that also acts as a secondary care facility for the local population and for some municipalities which do not have a regional hospital  5 Regional Secondary Care Hospitals  5 City Hospitals that are structured similarly to Regional Hospitals but with a smaller range of services  8 community facilities; 8 integrated houses and 1 Integrated Centre which provide mental health care additional to hospital psychiatric beds  1 Tertiary Dental Facility  1 Occupational Medicine Institute  10 TB units which include diagnostic centers and 3 TB units without diagnostic ability  7 Institutes of Public Health. (It was advised by the Ministry of Health (MSH) that the one of the Occupational Health facilities is not considered part of the health network.) PRIMARY CARE  31 Main Family Health Centers, 13 of which have maternity units  154 Family Health Centers  251 Ambulancas/punkts. The total number of facilities is complicated by the parallel health system servicing Serbian communities. Some municipalities do not count these facilities and some do. Serbian facilities have also been separately identified to the extent this data is available. Report 2: Data ______________________________________________________________________________________ 21 ____________________________________________________________________________ Kosovo Health Master Plan Sixty-two of the primary care facilities and three of the hospitals listed above are serving people in Kosovo wishing to use the Serbian health system. The full list of facilities identified is in Appendix II. The flow of patients generally follows that of many countries with a reasonably developed primary care network. In Kosovo, although a patient is assigned to a particular primary health care (PHC) facility - and sometimes to a particular doctor - where their health record is kept, it is not mandatory to only visit that centre. Also, the registration Health Care Cards have not been supplied by the MSH for some time and most centres have ceased registering patients. Patients in rural areas generally visit the nearest primary care doctor (ambulanca/punkt - AMF), and after hours visit the extended hours (Main) Family Medicine Centre. Patients in towns tend to visit either the Family Medicine Center assigned, which may be the Main Family Medicine Center (QKMF), and after hours also visit the extended hours (Main) Family Medicine Centre. Patients may also have to visit another facility (usually the Main Family Medicine Centre) for laboratory and XRay investigations. Some specialists are employed in Family Medicine Centres (QMF), including a range of specialists not normally found in primary care who are usually being employed until retirement. If it is necessary to refer a patient to a higher level of care, a written referral is required. Patients can attend a secondary care facility directly without a referral in the case of an emergency. If it turns out that it is not an emergency then they pay a co- payment (assuming that they are not in one of the many co-payment exempt categories). Report 2: Data ______________________________________________________________________________________ 22 ____________________________________________________________________________ Kosovo Health Master Plan 4. HEALTH CONCERNS The Health Priorities Working Group appointed by the MSH is to recommend the top health priorities for Kosovo. This is to ensure that the Health System Network provides access to the services needed to address the conditions causing most problems in Kosovo. All facilities and departments were asked to provide the top conditions which patients present. Not all facilities collect such data routinely. In prioritising diseases a number of factors need to be taken into account including the prevalence of the condition, the condition’s susceptibility to prevention and treatment; seriousness of the condition and its impact on the life of the patient; risk to the general population if the disease is not treated; and the cost to the patient and community of treating and not treating the condition, among many other factors. Information presented here is being used to assist the Working Group’s deliberations. REASONS FOR SEEKING PRIMARY HEALTH CARE The tables below show that a number of conditions are very common in Kosovo across all three levels of care: Infections including respiratory and throat, bronchitis, pneumonia and ear; gastroenteritis; hypertension; and diabetes. Depression and post traumatic stress disorder are reported in other studies in Kosovo to also cause significant disease burden. Table 1: Most common reasons for visiting Kacanik primary care facilities Description ICD 10 Code Number of patients General exam or investigation without complaint or diagnosis Z00 5522 Pharyngitis or tonsillitis acute J02-03 3064 Supervision normal pregnancy Z34 1227 Hypertension I10 1164 Influenza J11 1060 Diarrhoea & gastroenteritis presumed infectious A09 957 Kyphosis and lordosis M40 716 Infections of the skin and subcutaneous tissue L00-L08 634 Common cold J00 541 Report 2: Data ______________________________________________________________________________________ 23 ____________________________________________________________________________ Kosovo Health Master Plan Table 1 (continued): Most common reasons for visiting Kacanik primary care facilities Description ICD 10 Code Number of patients Abnormalities of heart beat R00 521 Bronchitis acute J20-21 489 Other medical care Z51 364 Pneumonia J12 356 Gastritis & duodenitis K29 288 Diabetes non insulin dependent E11 284 Otitis externa H60 266 Scabies B86 242 Migraine G43 229 Varicella B01 223 Polyarthrosis M15 227 Table 2: Most common reasons for visiting Mitrovice primary care facilities in March 2008 Description ICD 10 Code Number of patients Acute pharyngitis & tonsillitis J02-03 974 Potential health hazards; pregnancy & fertility Z31-33, 37, 55-99 948 Primary hypertension I10 634 Exams & investigations Z00-Z13 601 Dorsopathies, spondolopathies, dorslagia M40-49, 53, 54 378 Influenza J10,11 339 Diabetes mellitus E10-14 258 Cystitis N30 253 Chronic diseases lower respiratory tract J40-44 189 R00-09, 11-49, 51, Circulatory & respiratory, nausea & vomiting 53, 55-99 163 Acute bronchitis J20-21 148 Gastritis and duodenitis K29 135 Migraine G43,44 121 Skin disorders L10-L99 94 Anaemia siderepenica D50 83 Conjunctivitis H10-13 75 Laryngitis J04 72 Abdominal & pelvic pain R10 71 Infections skin and subcutaneous tissue L00-08 66 Endocrine disorders; fluid & electrolytes, E15-35,58- minerals; obesity; amylodosis 63,65,67,85,87-90 62 Report 2: Data ______________________________________________________________________________________ 24 ____________________________________________________________________________ Kosovo Health Master Plan Table 2 (continued): Most common reasons for visiting Mitrovice primary care facilities in March 2008 Description ICD 10 Code Number of patients Arthroses M15-19 53 Soft tissue disorders M60-79 53 S00, 04,09-11, 14, Injuries & wounds 16, 53 Diarrhoea & gastroenteritis A09 47 URTI J00,01,05,06 46 H60-62, 80-83, 92- Diseases external & inner ear 95 39 Antenatal services Z34-36 39 Table 3: Most common reasons for visiting Gjilan Main Family Medicine Centre (QKMF) Description ICD 10 Code Common cold J.00 Acute tonsillitis J.03 Hypertension I10 Dorsalgia M54 Non insulin dependent diabetes E11 Calculus of kidney and ureter N20 Table 4: Most common reasons for visiting Gjakove QKMF Description Urinary tract infection Renal colic Biliary colic Tonsillitis/pharyngitis Bronchitis Hypertension Headache Diabetes Diarrhoea Sinusitis Otitis Myalgia Polyarthrosis Report 2: Data ______________________________________________________________________________________ 25 ____________________________________________________________________________ Kosovo Health Master Plan Gastritis Hernia Injuries including burns Allergy Cardiomyopathy Hyperlipidemia NUMBER OF INSULIN DEPENDENT DIABETICS & HAEMODIALYSIS PATIENTS Renal disease and diabetes management were common topics of discussion in the interviews, mainly because of the problems with obtaining insulin supplies and the health and financial impact this has on their patients, and because of the financial and resource load that transporting dialysis patients poses for primary health care. Table 5 shows the number of patients in each municipality with insulin dependent diabetes and the number of patients in each municipality who are undergoing dialysis. People in municipalities with dialysis units often do not know the number of patients being dialyzed in their Unit who are from their municipality. The total number of people undergoing dialysis in Kosovo is around 548. Over 3634 rely on insulin. Table 5: Insulin dependent diabetics and haemodialysis patients in each municipality Insulin Dialysis Dialysis patients/ Municipality dependent patients Dialysed in dialysis centre Decan 97 11 Peje Dragash 60 10 Prizren Ferizaj 153 35 Gjilan Fushe Kosove 89 7 Prishtine Gjakova 351 Gjakova 31 Gjilan 210 Gjilan 96 Gllogoc 13 Prishtine Hani I Elezit 9 4 Gjilan Istog 80 16 Peje Junik 18 0 Kacanik 33 8 Gjilan Kamenice 60 6 Gjilan Kline 65 13 Peje Lipjan 90 8 Prishtine Report 2: Data ______________________________________________________________________________________ 26 ____________________________________________________________________________ Kosovo Health Master Plan Table 5 (continued): Insulin dependent diabetics and haemodialysis patients in each municipality Insulin Dialysis Dialysis patients/ Municipality dependent patients Dialysed in dialysis centre Malisheve 60 16 Mamushe 3 0 Prizren 76 (11 in Nth Mitrovice Sth 173 Mitrovice Mitrovice) Novoberde 2 2 Gjilan Obiliq 34 6 Prishtine Peje 389 Peje 80 Podujeve 171 22 Prishtine Prishtina 610 50 Prishtine 150 Prizren 316 Prizren 138 Rahovec 83 26 Prizren Serbian patients - Shterpce 6 1 Gjilan Belgrade Shtime 29 9 Prishtine Skenderaj 57 18 Mitrovice Suhareke 101 30 Viti 75 22 Gjilan Vushtrri 210 19 Mitrovice REASONS FOR SEEKING OUTPATIENT CARE AT QKUK Table 6: Most common reasons for Outpatient Visit at QKUK ICD description ICD code Number of patients Hypertensive heart disease I11 4680 Essential (primary) hypertension I10 3300 Non-insulin-dependent diabetes mellitus E11 2545 Dyspepsia K30 2520 Iron deficiency anaemia D50 1800 Spondylosis M47 1603 Angina pectoris I20 1540 Acute myocardial infarction I21 1166 Chronic ischaemic heart disease I25 1000 Gastritis and duodenitis K29 668 Haemorrhoids I84 652 Seropositive rheumatoid arthritis M05 627 Acute renal failure N17 589 Insulin-dependent diabetes mellitus E10 531 Report 2: Data ______________________________________________________________________________________ 27 ____________________________________________________________________________ Kosovo Health Master Plan Table 6 (continued): Most common reasons for Outpatient Visit at QKUK ICD description ICD code Number of patients Duodenal ulcer K26 520 Gonarthrosis [arthrosis of knee] M17 497 Polycythaemia vera D45 400 Reactive arthropathies M02 335 Other functional intestinal disorders K59 322 Myeloid leukaemia C92 300 Congenital hypothyroidism with diffuse goitre E03.0 300 Chronic renal failure N18 274 Thyrotoxicosis with diffuse goitre E05.0 200 Tubulo-interstitial nephritis, not specified N12 167 Other specific arthropathies M12 154 Systemic lupus erythematosus M32 150 REASON FOR ADMISSION - SECONDARY CARE The top reasons for seeking care in hospitals are in many cases the same as in primary care. In addition, many of the top conditions (such as hypertension, diabetes, nutritional disorders, asthma, diarrhoea, tonsillitis/pharyngitis) are those classified as Ambulatory Care Sensitive Conditions which, if managed well in primary care, should be seen in much smaller numbers in hospital. Table 7: Most common reasons for admission to Prizren Hospital Description ICD code Number of patients Essential (primary) hypertension I10 1948 Streptococcal tonsillitis J03 1828 Asthma J45 1239 Diarrhoea & gastroenteritis presumed infectious A09 1196 Chronic diseases of tonsils and adenoids J35 960 Acute pharyngitis J02 906 Acute nasopharyngitis (common cold) J00 876 Cutaneous abscess L02 800 Pneumonia J18 743 Spondylosis M47 708 Amnesia, not induced by alcohol etc F04 700 Chronic renal failure N18 664 Cholelithiasis K80 611 Calculus of lower urinary tract N21 589 Inguinal hernia K40 503 Gastritis and duodenitis K29 498 Report 2: Data ______________________________________________________________________________________ 28 ____________________________________________________________________________ Kosovo Health Master Plan Table 7 (continued): Most common reasons for admission to Prizren Hospital Description ICD code Number of patients Gonarthrosis [arthrosis of knee] M17 497 Acute bronchiolitis J21 491 Bronchitis, not specified as acute or chronic J40 478 acute laryngitis J04 469 Blepharitis H10 467 Hyperplasia of prostate N40 466 Dorsalgia M54 449 Other intervertebral disc disorders M51 448 SECONDARY + TERTIARY CARE - SOME QKUK DEPARTMENTS Table 8: Most common reasons for admission - QKUK Cardiology Department & Coronary Care Unit Description Clinic name ICD code Number of patients Acute myocardial infarction CCU I21 686 Essential (primary) hypertension Cardiology 1+2 I10 248 Acute myocardial infarction Cardiology 1 I21 168 Non-insulin-dependent diabetes mellitus Cardiology 1+2 E11 150 Heart failure Cardiology 1 I50 140 Essential hypertension, Ischaemic I10,I11, cardiomyopathy, Hypertensive heart disease Cardiology 1+2 I42.8 116 Angina pectoris Cardiology 2 I20 112 Bronchitis Cardiology 1+2 J40,J42 100 Cardiomyopathy Cardiology 2 I42 89 Old myocardial infarction Cardiology 1 I25.2 70 Cardiomyopathy CCU I42 49 Cardiac arrest Cardiology 2 I46 35 Atrial fibrillation and flutter Cardiology 1 I49 30 Atrial fibrillation and flutter CCU I49 30 Table 9: Most common reasons for admission to Endocrinology Department ICD description ICD code Number of patients Iodine-deficiency-related multinodular (endemic) goitre E011 280 Cardiomyopathy I42 114 Iodine-deficiency-related diffuse (endemic) goitre(? E01.0) E010 80 Cerebral palsy G80 75 Acute myocardial infarction I21 30 Chronic renal failure N18 22 Report 2: Data ______________________________________________________________________________________ 29 ____________________________________________________________________________ Kosovo Health Master Plan Table 9 (continued): Most common reasons for admission to Endocrinology Department ICD description ICD code Number of patients Hereditary nephropathy, not elsewhere classified N07 21 Gastritis and duodenitis K29 20 Other hypothyroidism E03 16 Thyrotoxicosis [hyperthyroidism] E05 16 Spondylosis M47 16 Other nontoxic goitre E04 15 Other mononeuropathies G58 12 Hemiplegia G81 12 Malignant neoplasm of liver and intrahepatic bile ducts C22 10 Idiopathic thrombocytopenic purpura D84 10 Cushings Syndrome E24 10 Subclinical iodine-deficiency hypothyroidism E02 9 Obesity E66 8 Nutritional and metabolic disorders in diseases classified elsewhere E90 8 Other endocrine disorders E34 7 Table 10: Most common reasons for admission to Gastroenterology Department ICD description ICD code Number of patients Gastric ulcer K25 160 Fibrosis and cirrhosis of liver K74 110 Gastritis and duodenitis K29 100 Other diseases of stomach and duodenum K31 100 Duodenal ulcer K26 80 Inguinal hernia K40 60 Gastritis and duodenitis K29 50 Malignant neoplasm of liver and intrahepatic bile ducts C22 30 Other diseases of digestive system K92 23 Malignant neoplasm of rectum C20 20 Malnutrition-related diabetes mellitus E12 20 Other pulmonary heart diseases I27 20 GORD K21 20 Crohn's disease [regional enteritis] K50 20 Other functional intestinal disorders K59 20 Malignant neoplasm of colon C18 15 Ulcerative colitis K51 15 Cholecystitis K81 15 Acute pancreatitis K85 15 Malignant neoplasm of small intestine C17 10 Report 2: Data ______________________________________________________________________________________ 30 ____________________________________________________________________________ Kosovo Health Master Plan Table 10 (continued): Most common reasons for admission to Gastroenterology Department ICD description ICD code Number of patients Malignant neoplasm of pancreas C25 10 Malignant neoplasm of other and ill-defined digestive organs C26 10 Mental and behavioural disorders due to volatile solvents F18 10 Oesophagitis K20 10 Table 11: Most common reasons for admission to Haematology Department ICD description ICD code Number of patients Iron deficiency anaemia D50 104 Multiple myeloma and malignant plasma cell neoplasms C90 45 Follicular [nodular] non-Hodgkin's lymphoma C82 35 Acute myeloid leukaemia C92.0 33 Vitamin B12 deficiency anaemia D51 31 Disease of blood and blood-forming organs, unspecified D75.9 29 Hodgkin's disease C81 21 Chronic myeloid leukaemia C92.1 19 Idiopathic thrombocytopenic purpura D69.3 16 Thrombocytopenia, unspecified D69.6 15 Chronic lymphocytic leukaemia C91.1 12 Other aplastic anaemias D61 10 Chronic congestive splenomegaly D73.2 9 Malignant neoplasm of adrenal gland (C74) C74.6 8 Hereditary factor VIII deficiency D66 8 Acute lymphoblastic leukaemia C91.0 6 Acquired haemolytic anaemia D59 6 Unspecified diabetes mellitus E14 6 Table 12: Most common reasons for admission to Nephrology Department ICD description ICD code Number of patients Chronic tubulo-interstitial nephritis N11 149 Chronic renal failure N18 114 Unspecified diabetes mellitus E14.2 52 Acute renal failure N17 37 Nephrotic syndrome N04 13 Cyst of kidney, acquired N28.1 12 Glomerular disorders in diseases classified elsewhere N08 8 Obstructive and reflux uropathy N13 8 Chronic gastritis, unspecified K29.5 7 Report 2: Data ______________________________________________________________________________________ 31 ____________________________________________________________________________ Kosovo Health Master Plan Table 12 (continued): Most common reasons for admission to Nephrology Department ICD description ICD code Number of patients Insulin-dependent diabetes mellitus E10 6 Essential (primary) hypertension I10 5 Acute tubulo-interstitial nephritis N10 5 Calculus of kidney with calculus of ureter N20.2 5 Hypertensive heart and renal disease with renal failure I13.1 4 Cardiomyopathy I42 3 Systemic lupus erythematosus with organ or system involvement M32.1 3 Septicaemia unspecified A41.9 2 Chronic tubulo-interstitial nephritis N11 2 Small kidney, unspecified N27.9 2 Malignant neoplasm of kidney, except renal pelvis C64 1 Other metabolic disorders E88 1 Pericarditis in other diseases classified elsewhere I32.8 1 Embolism and thrombosis of unspecified vein I82.9 1 Table 13: Most common reasons for admission to Rheumatology Department ICD description ICD code Number of patients Seropositive rheumatoid arthritis M05 109 Spondylosis M47 69 Other dorsopathies, not elsewhere classified M53 21 Polyarthrosis M15 18 Reactive arthropathies M02 16 Inflammatory polyarthropathy M06.4 10 Systemic lupus erythematosus M32 9 Spondylosis M47 7 Dorsalgia M54 7 Osteoporosis without pathological fracture M81 7 Gonarthrosis [arthrosis of knee] M17 6 Behcet's disease M35.2 6 Other intervertebral disc disorders M51 6 Table 14: Most common reasons for admission – 6 of the QKUK Clinics Description ICD code Number patients Acute myocardial infarction I21 884 Oesophagitis, gastritis, duodenitis, ulcers K20, 21, 25, 29, 29.5, 31 547 Disorders of thyroid gland E00-07 421 Report 2: Data ______________________________________________________________________________________ 32 ____________________________________________________________________________ Kosovo Health Master Plan Table 14 (continued): Most common reasons for admission – 6 of the QKUK Clinics Description ICD code Number patients N04, 07, 08, 10, 11, 13, 17, 18, 20.2, Renal disorders 27.9. 28.1 398 Rheumatoid & arthroses etc M02, 05, 15, 17, 32, 32.1, 35.2 355 Other GI & organ disorders K40, K50, 59, 74, 81, 85, 92 278 Cardiomyopathy I42 315 Essential (primary) hypertension I10-15 313 Diabetes mellitus E10-E14 234 Lymphomas & leukaemias C81, 82, 90, 91.0. 91.1, 92.0, 92.1 171 Nutritional anaemias & other nutritional disorders D50, 51, E90 143 Heart failure I50 140 Spondylosis & disc disorders M47, 51, 53, 54 126 Angina pectoris I20 112 Malignant neoplasm of GI tract & organs C17, 18, 20, 22, 25, 26, 64, 74.6 104 Other anaemias and blood diseases D59, 61, 66, 69.3, 73.2, 75.9, 84 103 Bronchitis J40,J42 100 Report 2: Data ______________________________________________________________________________________ 33 ____________________________________________________________________________ Kosovo Health Master Plan 5. FINDINGS – INFRASTRUCTURE POPULATION AND POPULATION MOVEMENTS It is well known that there has not been an official population census in Kosovo since 1981. Municipalities attempt to estimate their populations, and there are official population estimates built into legislation2 which can differ markedly from local estimates (see 15). Table 15: Population Estimates Municipality 2008 Law on LGF 2008 local % difference local & Municipality estimates 2006 estimates estimates MEF estimates Decan 65000 40400 65000 60.89 Dragash 46000 35000 35000 0 Ferizaj 144351 111000 160000 44.14 Fushe Kosove 41412 33682 60000 78.14 Gjakova 153000 115000 150000 30.43 Gjilan 142845 100348 135000 34.53 Gllogoc (Drenas) 81847 60000 81000 35 Gracinice 18642 18642 Hani I Elezit 10000 10000 12000 20 Istog (Burim) 64342 44000 60000 36.36 Junik 9600 12500 30.21 Kacanik 43000 33000 50000 51.52 Kamenice 57000 49581 60000 21.01 Kline 59035 44000 75000 70.45 Kllokot 4542 Leposavic 19000 19000 19000 Lipjan 88887 69115 82000 18.64 Malisheve 65000 52000 100000 92.31 Mamushe 6000 6000 Mitrovice Nth 20000 20000 Mitrovice Sth 142200 90000 100000 11.11 Novoberde 3950 9899 5000 -49.5 Obiliq (Kastriot) 32500 26000 40000 53.85 Partesh 5217 Peje 160000 115000 318000 176.5 2 Eg Law on Local Government Finance Law No 2008/ for General Grant purposes Report 2: Data ______________________________________________________________________________________ 34 ____________________________________________________________________________ Kosovo Health Master Plan Table 15 (continued): Population Estimates Municipality 2008 Law on LGF 2008 local % difference local & Municipality estimates 2006 estimates estimates MEF estimates Podujeve (Bresiane) 127100 117000 120000 2.564 Prishtina 355000 388561 500000 28.68 Prizren 249614 214963 250000 16.3 Rahovec 75000 63000 80000 26.98 Ranillug 4955 Shterpce 16000 11000 15000 36.36 Shtime 35000 28000 35000 25 Skenderaj 73100 56000 72000 28.57 Suhareke 85000 80000 85000 6.25 Viti 69200 46458 70000 50.67 Vushtrri 105804 75000 105000 40 Zubin Potoc 15000 15000 15000 Zvecan 16000 16000 16000 Total Kosovo population 2,641,187 2,236,963 3,027,142 35.32% Notes: 1. italics= data not yet received – the municipality’s 2006 estimate is used, or when not available, MEF 2008 Law estimates 2. Under new structure new municipalities (Kllotok, Partesh & Ranillug (populations included with current municipality) Gracinice, Nth Mitrovice); plus Novoberbe gains settlements (and population) currently part of Kamenice and Gjilan Despite reporting significantly lowered birth rates over the past few years and high rates of migration, many Municipalities also report that their population is increasing and most believe the current Financing estimates are an underestimate of their population (average 35%). Municipalities also generally report a movement of population to their main city from the rural areas due to lack of infrastructure or employment opportunities, however many still have significant percentages of their population living in rural areas. Municipalities also generally describe their population as young with a large percentage of unemployed people, except for those municipalities with pockets of minority groups described as elderly. Most municipalities report reasonable access to some type of primary care, if not necessarily the full range of primary care services available in the QKMF, with laboratory, XRay and specialist services available 6-8 hour there, and consultations available 24 hours. Punkts, staffed 5 days a week for 6-8 hours by a Report 2: Data ______________________________________________________________________________________ 35 ____________________________________________________________________________ Kosovo Health Master Plan nurse, and mostly 1-3 days a week by a doctor, are widely accessible, but offer a reduced range of services. The longest time reported to travel to the Main Family Medicine Centre is in Mitrovice and Drenas, where a couple of villages are 40-60 minutes away, mainly due to poor roads. The furthest village from hospital care reported was in Dragash (2 hours). For purposes of setting parameters for the health network, the Law on Local Government population estimates will be used as the denominator, and the relatively young average age of the population will be taken into account when estimating service needs into the future. However for municipalities where local population estimates vary significantly from official estimates (eg Peje, Malisheve, Kline, Fushe Kosovo, Decan, Viti, Obiliq), current service use will be specifically checked to ensure no disadvantage impacting health will result from using the smaller population estimate. CAPITAL INVESTMENT In almost all municipalities we inspected there was evidence of new construction taking place in regional hospitals and/or primary care facilities. It appears to be easier to obtain funding for the construction of new facilities than it is to improve and maintain existing facilities. In a number of relatively newly constructed buildings there is already evidence of poor maintenance and infrastructure failure, for example new buildings connected to already inadequate water and drainage systems. There have also been many renovations seen where the logic of the choice of renovation project is not immediately apparent, as it seems not to have improved the particular underlying situation. It is clear that much of the work is not well planned and possibly not well executed. The apparent lack of ongoing maintenance budget and sometime even staffing for the buildings would suggest that they will rapidly deteriorate. The problem is reflected in the relatively high percentage of the health budget assigned to capital investment in Kosovo compared with other countries. It is acknowledged that there needed to be substantial investment in buildings after the war, however the choice of which buildings to invest in now seems to be based on parameters other than facility-level needs analysis or Kosovo-wide prioritization of need. Also of concern are indications that renovations and building work are substandard, with many recent renovations already showing signs of poor work, and also not being designed to health care facility standards with respect to flooring, furnishings and wall finishes, for example. Report 2: Data ______________________________________________________________________________________ 36 ____________________________________________________________________________ Kosovo Health Master Plan ASSESSING SUITABILITY AS A HEALTH FACILITY Drainage problems, leaking pipes, leaking roofs and heating problems were the main concerns about buildings for facility managers. A number of AMF do not have drainage or water at all. Also of concern to us were the number of facilities with floor and wall surfaces that were impossible to properly clean and disinfect. During the interview/site visit process undertaken through this Project a large number of areas were inspected, some of which related to issues that are commonly raised during accreditation inspections. The process included the development of a checklist for use by all the project personnel undertaking the visits. There were 20 questions that related to the infrastructure and maintenance of the buildings, such as whether electrical wiring is covered, as well as internal management, such as whether clinical waste is properly managed. Inspections were made of the exterior of each building as well as the condition of the interior of each building on all levels. Light bulbs were generally covered, no smoking policies were mostly observed, and only a few facilities had exposed electrical wiring, or jagged surfaces. However only a handful of facilities had intact seamless floors and washable walls. Even newly built facilities have put in floors which were not easily cleaned and collected dirt. As an average the QKUK clinics potentially complied with 6 out of the 20 issues. The range was broad however with 2 building scoring zero while others scored 15 out of 20. There were several examples seen here of clinical waste being left for many hours in open waste bins in public areas. HEATING, COOLING, AND GENERATORS Few facilities had airconditioning (less than 10%), and those that did were mostly in specific areas. Around 65% facilities had heating, but often it is not used due to fuel costs. Some facilities had reverted to coke heating due to this problem. Many facilities had basic firefighting equipment - fire extinguishers, which would be inadequate for serious fires, and only a handful had smoke alarms. The existence of backup generators is less frequent in primary care than in secondary and tertiary care facilities, about 40% of PHC facilities having working generators. Sometimes a generator is available, but is not used because of fuel Report 2: Data ______________________________________________________________________________________ 37 ____________________________________________________________________________ Kosovo Health Master Plan costs, or it is used only to power restricted areas such as operating theatres, dialysis unit, maternity, ICU, for example. DRAINS AND WATER Just over half the buildings viewed had access to hot water and many facility areas and departments did not have access to soap, let alone antiseptic handwashing facilities. Only 28% of facilities reported that they had adequate drainage. Drainage problems were frequently poor enough to have caused the closing of some toilets and many other toilet areas being used showed symptoms of poor drainage. Water supply is also a problem in a number of facilities, either not being connected at all, or not having a reservoir, or not having pipes to connect the reservoir. Addressing these basic safety issues is a priority. CLEANING AND MAINTENANCE OF HEALTH FACILITIES The quality of overall cleaning and maintenance is quite inadequate in the majority of facilities. Of the almost 80 separate buildings that were identified throughout the site visits (across all levels of care) the number of buildings where maintenance of floors, walls and windows etc were adequate for infection control was only a handful. In addition to this, in a number of facilities clinical waste was evident in public areas for many hours of the day. In some facilities it was obvious that they were devoting the materials and staff they had to keeping ward areas clean over keeping general access areas clean, which is a reasonable approach with limited resources, but certainly has flow on effects for general hygiene, and is not a sustainable solution. Overall, we considered that only 50% of the facilities could be regarded as clean to health facility standards. Reasons for the current situation are many, including the low salaries of cleaners, lack of cleaning staff, lack of appropriate equipment, unsuitable surfaces, lack of protocols, and lack of supervision. To remedy many of these issues requires a relatively small amount of investment in supplies and equipment, and appropriate management. Report 2: Data ______________________________________________________________________________________ 38 ____________________________________________________________________________ Kosovo Health Master Plan STRUCTURES FOR MONITORING HEALTH QUALITY The structures for monitoring the quality of delivery of health services have been established in both Main Family Medicine Centres and hospitals. These structures have usually been mandated by regulation centrally and consist mainly of multiple committees which allow input from different groups of staff from team and department level to Board level. In small organizations such as Main Family Medicine Centres the committee structure becomes more topics based. Committees usual cover:  Discipline  Complaints  Inventory  Quality  Professional matters  Ethics  Committees covering different professional areas. Quality coordinators form part of these structures in all municipalities. Discussion about the activities of these committees indicate they are focused more on discipline and investigating complaints than quality improvement, although a few facilities are using this structure in more innovative ways, for example, by conducting patient satisfaction surveys. In very few situations are the day to day use of clinical guidelines, protocols or any form of clinical performance indicators evident. Many facilities are aware of the availability of guidelines but lack the funding to print and distribute them. The MSH has a team of inspectors who have a checklist of items to inspect to ensure that structures and processes are in place, including:  Formation of committees and  Waiting list management commissions  Intrahospital and other  Existence of rules and infections procedures  Waste management  Employee evaluation  Hygiene management  Licenses  Medical records and security  Laws and standards  Drug inventory management  Sterilization  Identity cards  Appropriate protective clothing  Training and education  Patient information  Disciplinary procedures  Complaints box  Valuables security  Emergency plan  Access to facility Report 2: Data ______________________________________________________________________________________ 39 ____________________________________________________________________________ Kosovo Health Master Plan  Referral system  Work hours  Medical protocols  Health information system  Ethics code  Quality of equipment and materials.  Confidentiality PRIVATE SECTOR ISSUES The interaction between the public and private sectors is very important and in order to understand the private sector better, efforts have been made to gather information on the sector during the site visits. People interviewed mentioned 143 private facilities specific to their areas, some of which are not licensed. The MSH has a list of around 600 registered private facilities. It rapidly became apparent during the visits that the low salaries paid to the public health sector employees (247 euro per month to doctors), combined with the approval for public sector doctors to be employed in the private sector for 4 hours per day, have resulted in almost 100% of specialist doctors, many non specialist doctors and some nurses working in the private sector. It appears that most doctors establish their own solo practices located either close to the hospital or in their private houses. It is only rarely that the private services add to the total range of services available in the area. This duplication has the potential to interact with the public sector in a number of ways. There may well be situations where the doctors use their public sector employment to identify patients who may be prepared to receive care in the private sector. This is not necessarily bad unless the doctor withholds his/her services from the public sector in order to drive people towards their private practice. There is also incentive to avoid repairing and supplying reagents and other material for equipment in the public sector, or even worse, deliberately damaging equipment, in order to push patients towards the private sector. It should be noted that this was not identified in the site visits, but the incentive is there. The solution to this is complex in that it inevitably needs to involve raising the salary of health care professionals to a point where engagement in private practice can be much more controlled and monitored. As salaries are such a large percentage of the health budget (Table 28), this would involve substantially increasing the health budget. Report 2: Data ______________________________________________________________________________________ 40 ____________________________________________________________________________ Kosovo Health Master Plan 6. FINDINGS –– ACTIVITIES PRIMARY HEALTH CARE SERVICES The Kosovo Health Law No 20044 specifies certain types of services that should be provided through primary care:  Promotion, prevention, treatment and rehabilitation of diseases, disorders and injuries  Health education  Immunization  Initial diagnosis and basic health care including minor surgeries  Promotion of oral health and basic dental health care  Community based mental health care  Community based rehabilitation  Provision of qualitative food and water. The legislation does not specify that each and every primary care facility should provide these services, rather that these services are made available. This being the case then the current network as described in this Report does provide the legally required services. Immunization for example is not provided in every punkt, but patients do have access to the service through a visiting team or the QKMF. Minor surgery does take place in primary care however in some situations seen during the site visits the required equipment and consumables, such as local anaesthetic and sutures are not available in the primary care clinics, so patients have to separately purchase those supplies. Further details of appropriate primary care services are described in regulations. An assessment of 48 primary health care facilities, including 23 QKMF, 13 QMF, and 12 AMF found the offering of the following services outlined (Table 16). Apart from these services, in the QKMF - and in a few of the very large municipalities in some QMF -some other specialist services are available, the most common being internal medicine, ORL, ophthalmology, pulmology and occupational medicine. The vaccination unit frequently has an epidemiologist. Some QKMFs have a psychologist. In addition the majority of QKMFs transport patients for dialysis and some provide maternity units. Report 2: Data ______________________________________________________________________________________ 41 ____________________________________________________________________________ Kosovo Health Master Plan Table 16: Services provided in primary health care Service Main Family Medicine Family Medicine Centre Punkt Centre Number Available in Number Available in Number Available in % of facilities % of facilities % of facilities Antenatal Care 23 100% 12 92% 0 0 Vaccination 23 100% 9 70% 0 0 Pharmacy 22 96% 7 54% 0 0 Laboratory 22 96% 4 31% 0 0 Emergency 20 87% 2 15% 0 0 Health promotion 19 83% 1 8% 0 0 Family medicine 18 78% 13 100% 12 100% Doctor home visits* 18 78% 2 15% 0 0 Home nursing visits* 18 78% 2 15% 0 0 Radiology 17 74% 0 0 0 0 Pediatrics 16 70% 8 61% 0 0 Ob/gyn consult 12 52% 2 15% 0 0 Occupational medicine 3 13% 0 0 0 0 Dental services 12 52% 9 69% 0 0 Palliative Care 11 48% 1 8% 0 0 School based dental 3 13% 0 0 0 0 services School based medical 2 9% 0 0 0 0 services *Home visits are always a team of doctor/ nurse/ driver. No separate home nursing is provided Table 17: Primary care consultations and referrals Total number Total other # total # emergency Municipality doctor visits/yr services referrals/yr cases/day Decan 346087 Dragash 95326 387 43 Ferizaj 27605 219563 16278 Fushe Kosovo 74760 5868 Gjakova 87048 209589 10677 36 Gjilan 131586 114146 31841 9 Gllogovc (Drenas) 111,784 210353 Hani I Elezit Istog 192802 5808 45 Junik 9615 10739 Report 2: Data ______________________________________________________________________________________ 42 ____________________________________________________________________________ Kosovo Health Master Plan Table 17 (continued): Primary care consultations and referrals Total number Total other # total # emergency Municipality doctor visits/yr services referrals/yr cases/day Kacanik 54877 Kamenice Kline 20 Leposavic Lipjan 68615 45 Malisheve 15 Mamushe Mitrovica Sth 65004 50478 70 Novoberde 1721 1550 Obiliq 50784 43 Peje 417145 506826 26494 10 Podujeve 152459 128927 90 Prishtina 216788 Prizren Rahovec Shterpce Shtime Skenderaj 104747 86467 1000 10 Suha Reka 227760 5926 45 Viti Vushtrri 12413 45 Zubin Potoc Zvecan Gracanica Mitrovice Nth Total 2,408,908 818,117 94,546 av 37/day Table 18: Primary care services – laboratory and radiology Municipality # lab tests/yr # lab patients/yr # radiology tests /yr # radiology patients/yr Decan 4800 57000 12000 Dragash 12600 4560 Ferizaj 89994 21905 12600 4560 Fushe Kosovo 4668 Gjakova 10855 6362 0 0 Gjilan 24007 1606(dental) 589 Gllogovc (Drenas) 62129 16800 Hani I Elezit Istog 4800 12000 2700 Report 2: Data ______________________________________________________________________________________ 43 ____________________________________________________________________________ Kosovo Health Master Plan Table 18 (continued): Primary care services – laboratory and radiology Municipality # lab tests/yr # lab patients/yr # radiology tests /yr # radiology patients/yr Junik 591 Kacanik Kamenice Kline 7000 Leposavic Lipjan 12000 4500 Malisheve Mamushe Mitrovica Sth 36000 Novoberde 444 Obiliq 7200 4800 Peje 49411 7592 9600 1705 Podujeve 70426 14400 7227 Prishtina 77838 39000 39410 12844 Prizren Rahovec 3600 3600 Shterpce Shtime 10000 5000 Skenderaj 7200 Suha Reka 14000 14400 54000 7200 Viti Vushtrri 7500 Zubin Potoc Zvecan Gracanica Mitrovice Nth Total 449,474 303,940 196,702 66,698 MATERNITY BEDS A decision was obviously made some years ago to develop a primary care maternity capability for routine deliveries. Prior to this, a significant number of women did not receive antenatal care and delivered at home. During the antenatal visits to these Units, potentially problematic pregnancies are largely identified and these are referred for hospital supervision and delivery. Making antenatal care and monitored delivery readily accessible is important in continuing to reduce Kosovo’s maternal and perinatal mortality rates. Acknowledging that these Units deal only with normal deliveries, many of these facilities compared favourably with maternity departments in some hospitals, Report 2: Data ______________________________________________________________________________________ 44 ____________________________________________________________________________ Kosovo Health Master Plan with regard to equipment, surroundings, cleanliness and suitability as a maternity unit. We have visited the 13 primary care based maternity units (3 of which are not official maternity units) that have a total of 143 maternity beds. Discussions held with the staff of these units suggest that the attitude to primary care maternity beds has changed somewhat as numbers of deliveries have fallen, and of recent time the staff numbers have been reduced, some beds have been closed and funding for 24 hour gynecologist services is not always available. All but 1 (Viti) has a gynecologist on call, but the gynecologist serving another unit (Podujeve) lives 35 km away. REGIONAL HOSPITAL STATISTICS BY DEPARTMENT Table 19: Ferizaj Hospital # FERIZAI # Beds Discharges Bed days ALOS ABO # doctors # residents nurses Gynecology 21 2450 2563 1.30 31.40% 6 22.5 Internal Diseases 14 173 2029 11.70 40.20% 5 14 Pediatrics 16 540 1196 5.00 29.30% 6 14 Surgery 16 875 1518 2.20 25.90% 2 14 TOTAL 64 4038 7306 1.81 31.28% 19 65 Table 20: Gjakova Regional Hospital GJAKOVA # Beds Discharges Bed days ALOS ABO # doctors # residents # nurses Coronary Unit 12 526 2992 5.70 68.30% 2.3 6.8 Dermatology 8 181 1221 6.70 41.80% 1 6 Gynecology 27 1056 4441 4.20 45.10% 6.1 15.3 Infectious Diseases 25 500 2304 4.60 25.20% 2 8 Intensive Care 4 200 551 2.80 37.70% 3 11.3 Internal Diseases 48 1663 14626 8.80 83.50% 8.5 16.8 Maternity 0 0 0 0.00 0.00% 0 16 Neonatology 33 2123 7134 3.40 59.50% 2 15 Neurology 24 695 6999 10.10 79.90% 3 13.5 Obstetrics 33 2492 10453 4.20 86.80% 6.1 14.8 Ophthalmology 15 240 1509 6.30 26.80% 2.3 6 ORL 12 237 1373 5.80 32.00% 3 5 Report 2: Data ______________________________________________________________________________________ 45 ____________________________________________________________________________ Kosovo Health Master Plan Table 20 (continued): Gjakova Regional Hospital GJAKOVA # Beds Discharges Bed days ALOS ABO # doctors # residents # nurses Orthopedic 17 464 3436 7.40 55.40% 3 10.8 Pediatrics 49 1628 7826 4.80 43.50% 8 24.1 Psychiatry 26 383 7092 18.50 74.70% 2 9 Surgery 44 1581 6533 4.10 40.40% 5.6 16.5 Thorax 24 781 7453 9.50 85.10% 3 7 Urology 14 525 2569 4.90 50.30% 3 8.7 TOTAL 415 15275 88512 5.79 58.43% 63.9 210.6 Table21 : Gjilan Regional Hospital GJILAN # Beds Discharges Bed days ALOS ABO # doctors # residents # nurses Coronary Unit 13 467 2855 6.10 60.20% 2 11 Dermatology 0 0 0 0.00 0.00% 0 0 Gynecology 47 1236 9091 7.40 53.00% 12 38 Infectious Diseases 32 931 5154 5.60 45.00% 7 10 Intensive Care 17 2006 1599 0.80 25.80% 17 13 Internal Diseases 57 1508 16219 10.80 78.00% 15.2 18 Maternity 8 0 0 0.00 0.00% 0 0 Neonatology 29 2365 4119 1.70 38.90% 8.2 12.3 Neurology 0 0 0 0.00 0.00% 0 0 Obstetrics 43 2494 6199 2.50 39.50% 0 0 Ophthalmology 0 0 0 0.00 0.00% 0 0 ORL 21 708 4838 6.50 63.10% 8 7 Orthopedic 18 389 2878 7.40 43.80% 5 7 Pediatrics 32 1095 5424 5.00 46.00% 7.4 14.8 Psychiatry 11 62 3136 50.60 78.10% 4.6 11 Surgery 27 1128 6224 5.50 63.20% 9.8 12 Thorax 32 453 8126 17.90 69.60% 5.3 9 Urology 15 538 3489 6.50 63.70% 4 7 TOTAL 402 15380 79351 5.16 54.08% 100 17 313 Table 22: Peje Regional Hospital PEJA # Beds Discharges Bed days ALOS ABO # doctors # residents # nurses Coronary Unit 12 536 2799 5.20 63.90% 3 20.8 Report 2: Data ______________________________________________________________________________________ 46 ____________________________________________________________________________ Kosovo Health Master Plan Table 22 (continued): Peje Regional Hospital PEJA # Beds Discharges Bed days ALOS ABO # doctors # residents # nurses Dermatology 8 137 1893 13.80 64.83% 2 2 Gynecology 31 1455 8488 5.80 75.02% 6 8.2 Infectious Diseases 24 697 5873 8.40 67.04% 3 12 Intensive Care 7 401 1086 2.70 42.50% 0.5 9.1 Internal Diseases 46 1044 11285 10.80 67.21% 8 15 Maternity 0 0 0 0.00 0.00% 0 0 Neonatology 41 2715 5340 2.00 35.68% 3 12.6 Neurology 14 538 3340 6.20 65.36% 3.4 10.3 Obstetrics 33 2784 6454 2.30 53.58% 6 16.8 Ophthalmology 11 160 2502 15.60 62.32% 3 4 ORL 18 218 1488 6.80 22.65% 3.3 4.3 Orthopedic 33 907 8858 9.80 73.54% 4 10.6 Pediatrics 28 1022 4296 4.20 42.04% 6 12.3 Psychiatry 18 226 3870 17.10 58.90% 4 6.1 Surgery 40 1652 8002 4.80 54.81% 7.5 13.3 Thorax 64 737 16354 22.20 70.01% 10 15 Urology 20 788 6087 7.70 83.38% 4 7.5 TOTAL 448 16017 98015 6.12 59.94% 105 4 299 Table 23: Prizren Regional Hospital PRIZREN # Beds Discharges Bed days ALOS ABO # doctors # residents # nurses Coronary Unit 10 306 1492 4.90 40.90% 2 10.3 Dermatology 7 22 472 21.50 17.60% 1.4 4.2 Gynecology 30 1774 6852 3.90 62.60% 4 9.8 Infectious Diseases 30 1165 5843 5.00 53.40% 2.3 12.3 Intensive Care 8 886 1794 2.00 61.40% 11 12.4 Internal Diseases 70 2475 18146 7.30 71.00% 13.1 18.1 Maternity 0 0 0 0.00 0.00% 1 14.3 Neonatology 28 4332 7882 1.80 77.10% 7 15.9 Neurology 25 821 6160 7.50 67.50% 4 16 Obstetrics 66 4995 13608 2.70 56.50% 15 14 Ophthalmology 25 618 4452 7.20 48.80% 7.3 11 ORL 31 1199 6445 5.40 57.00% 7.9 14.2 Orthopedic 27 908 5909 6.50 60.00% 6.5 11.6 Pediatrics 70 2282 12738 5.60 49.90% 12 25.8 Psychiatry 26 435 2901 6.70 30.60% 3 15 Surgery 55 3228 12809 4.00 63.80% 15 14.8 Report 2: Data ______________________________________________________________________________________ 47 ____________________________________________________________________________ Kosovo Health Master Plan Table 23: Prizren Regional Hospital PRIZREN # Beds Discharges Bed days ALOS ABO # doctors # residents # nurses Thorax 45 486 9367 19.30 57.00% 8 13.7 Urology 24 636 3865 6.10 44.10% 5 8.6 TOTAL 578 26568 120735 4.53 64.73% 125.5 242 Table 24: Vushtrri Hospital VUSHTRRI # Beds Discharges Bed days ALOS ABO # doctors # residents # nurses Gynecology 11 595 2399 1.65 59.80% 2 5 Intensive Care 6 581 1252 1.61 57.20% 3.3 9 Internal Diseases 12 238 2426 0.66 60.40% 2 8 Maternity 4 976 0 2.94 0.00% 1.3 4 Obstetrics 12 155 2326 2.30 53.10% 1 8 Pediatrics 17 411 2161 1.14 34.80% 3 7 Surgery 15 1005 3855 2.79 69.30% 7 24 TOTAL 78 3961 14419 3.64 54.70% 19.6 65 Table 25: All regional hospitals Regional Hospital # Beds Discharges Bed days ALOS ABO # doctors # residents # nurses 64 4038 7306 1.81 31.28% 30 137 Ferizaj 415 15275 88512 5.79 58.43% 63.9 210.6 Gjakova 402 15380 79351 5.16 54.08% 100 17 313 Gjilan 0 0 0 38 177 Mitrovice 448 16017 98015 6.12 59.94% 105 4 299 Peje 578 26568 120735 4.53 64.73% 125.5 242 Prizren 78 3961 14419 3.64 54.70% 19.6 65 Vushtrri TOTAL 1,985 81,239 408,338 5.0 56% 482 21 1,444 Report 2: Data ______________________________________________________________________________________ 48 ____________________________________________________________________________ Kosovo Health Master Plan Table 26: Prishtina University Clinical Center by Department Department name # Beds Discharges Bed days ALOS ABO # docs # res # nurses MEDICAL Cardiology 1 18 888 7851 8.61 119.50% 6 4 9 Cardiology 2 18 924 5414 7.05 82.40% 10 1 14 CCU 13 888 4356 5.04 91.80% 5 6 17 Dermatovenerology 40 681 9231 13.68 57.50% 18 26 Endocrinology 38 720 9764 14.03 70.40% 5 2 13 Gastroenterology 38 1260 11776 9.09 84.90% 7 6 17 Hematology 27 480 7716 16.08 78.30% 4 6 16 Infectious Diseases 109 1683 30456 18.23 76.55% 10 60 Nephrology 26 480 6415 11.88 67.60% 8 8 13 Neurology 87 3633 24807 7.90 74.00% 14 13 61 Pediatrics 240 4980 50679 10.60 57.85% 38 130 Pulmology 77 1481 23052 15.76 86.70% 12 12 31 Rheumatology 26 456 7526 15.68 79.30% 4 2 11 Psychiatry - general & ICU 95 939 20676 18.50 59.63% 11 46 Psychiatry - ICU 14 194 3225 18.1 74.00% 2 15 18 SURGICAL Abdominal Surgery A 20 504 4168 8.08 57.10% 7 2 12 Abdominal Surgery B 20 900 5395 5.69 73.90% 8 4 13 Abdominal Surgery C 20 720 6300 9.55 86.30% 6 2 12 Abdominal Surgery HB 20 612 5358 9.92 73.40% 8 3 12 Maxillofacial 40 531 5442 9.70 37.27% 6 14 Neurosurgery 44 1104 11817 10.37 92.60% 8 3 25 Ophthalmology 54 1788 11685 6.30 59.28% 19 10 62 ORL 73 3018 22458 9.60 85.00% 16 5 59 Orthopedic Surgery 106 1692 24177 15.30 62.49% 37 4 91 Pediatric Surgery 38 1683 8946 6.90 63.20% 7 10 20 Plastic Surgery 22 696 6440 8.01 80.20% 6 3 13 Thoracic Surgery 36 744 13850 24.04 105.40% 6 4 22 Urological Surgery 40 690 4500 12.10 49.60% 10 4 22 Vascular Surgery 38 744 11984 18.49 86.40% 9 1 19 OBS and GYN Delivery Rooms 11 Gynecology incl neonatal 369 43617 119796 2.60 87.30% 43 27 204 Neonatal ICU 100 10038 28824 2.80 77.50% 11 50 TOTAL 1,917 89,038 514,084 361 179 1,132 Report 2: Data ______________________________________________________________________________________ 49 ____________________________________________________________________________ Kosovo Health Master Plan Table 27: Laboratory and XRay services in Hospitals Number lab Department name tests/year Number XRay test/year Infectious Diseases 31242 940 Neurology 5653 \ Psychiatry - general & ICU 8217 \ Psychiatry - ICU 2982 \ Ophthalmology 22919 120 ORL 3626 Gynecology incl neonatal 169812 Total 804,000 72,000 HEALTH INFORMATION SYSTEM There have been several attempts over the years to introduce a health information system and to gather data necessary for health planning, with varying degrees of success. During the site visits to a number of the main family health centers, examination was made of the systems and the process undertaken by the staff to enter the data. The nature of the system and the fact that the data is initially entered on paper by administration and clinical staff and then entered into the HIS by data entry clerks, raises the possibility of significant coding and other data entry errors. It was also mentioned in a number of facilities that they had stopped entering data some time ago due to some technical problem. The personnel also raised the issue that they did not receive any feedback about all the data they provided to the NIPH. It is clear that the current health information system is not adequate for the needs of facilities. There has been a strategic plan for health information prepared by a committee with representation from both NIPH and MSH and the plan has recently been reviewed. Work should continue to progress this plan. Report 2: Data ______________________________________________________________________________________ 50 ____________________________________________________________________________ Kosovo Health Master Plan 7. FINDINGS - RESOURCES BUDGETING Funding for health at the primary care level comes from three basic sources shown in Table 28. Staff salaries are paid directly from the Ministry of Economy and Finance (MEF) and 40% of the Goods & Services (G&S) part of the central health care budget is diverted to the MSH for EDL drugs supply; an MEF grant based on population estimates is provided to municipalities for supporting their primary health care facilities; and ‘self generated revenue’ ie money derived from copayments for services by the few groups which are not exempt. Some municipalities also provide an additional grant for further support of PHC services or of specific patients (eg with cancer). The figures below were provided by municipality H&SW areas and some inconsistencies are apparent. Table 28: Funding for Primary Health Care Municipal Total PHC MEF grant Salaries G&S Utilities Copayments health budget Municipality total component component component revenue grant (1) Decan 307835 287254 37581 25000 30000 42000 379835 Dragash 315053 231220 65833 18000 38562 2630 671298 Ferizaj 1152440 800222 279649 36896 117405 10000 1279845 Fushe Kosove 281753 108000 23841 10000 8000 289753 Gjakova 925667 84000 100000 40326 40000 40326 1005993 Gjilan 1133700 665370 85140 35000 248000 48000 1429700 Gllogoc 483005 442263 127414 37479 69200 82260 634465 Hani I Elezit 41000 0 41000 Istog 354204 354204 Junik 94778 56393 31885 6500 94778 Kacanik 346825 260648 86177 31000 80000 457825 Kamenice 0 Kline 495148 326754 138394 25000 33000 5000 533148 Lipjan 598493 33482 22439 38359 19788 712561 Malisheve 458725 93609 77679 17985 55000 513725 Mamushe 0 Mitrovice N 0 Report 2: Data ______________________________________________________________________________________ 51 ____________________________________________________________________________ Kosovo Health Master Plan Table 28 (continued): Funding for Primary Health Care Goods & Municipal Total PHC MEF grant Salaries services Utilities Copayments health budget Municipality total component component component revenue grant (1) Mitrovice S 866770 662552 138218 66000 43544 910314 Novoberde 43250 438 43688 Obiliq 17000 17000 Peje 1240000 920000 65000 80000 45000 1285000 Podujeve 973757 577195 265665 39000 8971 26503 1009231 Prishtina 3220036 2097619 742400 291046 102000 3322036 Prizren 1730000 1171000 457000 75000 210000 20400 1960400 Rahovec 512156 281103 186180 44873 45878 3000 561034 Shterpce 88000 66000 14000 7000 1000 0 89000 Shtime 225403 167003 38600 11800 25000 25000 275403 Skenderaj 648131 126871 35315 20197 830514 Suhareke 720000 340541 215385 30000 40000 25000 785000 Viti 129924 22359 152283 Vushtrri 603757 461710 106647 35400 50000 653757 Zubin Potoc 0 Zvecan 0 +Sums where 1691103 no MEF total Sub Total 16257209 10904817 3486551 974939 1248354 347637 19658235 +40% total G&S 2324367 2324367 2324367 20104727 10904817 5810918 974939 1248354 429907 21700728 % PHC 92.6 61.6 32.8 5.5 5.8 1.6 budget Note: 1. Total budget = MEF grant + copayment revenue + municipal health grant 2. MEF deducts 40% G&S budget and provides directly to MSH for the supply of EDL drugs 3. The %PHC budget is calculated as: % income for MEF grant, SGR and municipal grant; and as % spending for 3 items for salaries, G&S and utilities PROCUREMENT A number of municipalities raised issues about the procurement process. They indicated that the processes are too complex and take too long, including for low value items. An example given was the procurement process required to service Report 2: Data ______________________________________________________________________________________ 52 ____________________________________________________________________________ Kosovo Health Master Plan the various emergency vehicles. The process effectively prevented them from attracting a suitable supplier, resulting in the many unserviced vehicles lying idle, while the need for emergency vehicles is high. A number of municipalities also indicated that, given the consistent failure to provide them with drugs from the Essential Drug List, they would like the opportunity to procure the required drugs themselves, such as insulin. A number of municipalities do this currently from extra municipal funds but find difficulties again eg with the procurement law that requires one contract to be finished before another contract be entered into, even if the original contractor is unable to fulfill the contract (for example by drugs being out of stock). Specific issues mentioned during the interviews also included the lack of auditing and monitoring in the procurement process, too much focus on low price, and the complexity of the process even for low value items. QKMF and Municipality Health Services Directors also believe that the municipal administrators do not understand the urgency of some of the health procurement needs. HOSPITAL DEPARTMENT STRUCTURE The regional hospital department structure is consistent throughout Kosovo, with the following departments: Coronary Unit Dermatology Infectious Diseases Intensive Care Internal Diseases Neonatology Neurology Pediatrics Psychiatry Thorax Obstetrics Maternity Gynecology Ophthalmology ORL Orthopedics Surgery Urology Report 2: Data ______________________________________________________________________________________ 53 ____________________________________________________________________________ Kosovo Health Master Plan Prishtina University Clinical Center reports to a similar structure, however site visits suggest that the following is the actual functional separation of the clinical specialties there: Coronary Unit Abdominal Surgery A Cardiology 1 Abdominal Surgery B Cardiology 2 Abdominal Surgery C Dermatovenerology Abdominal Surgery HB Endocrinology Maternity Delivery Rooms Gastroenterology Gynecology including neonatal Hematology Maxillofacial Infectious Diseases Neonatal ICU Nephrology Neurosurgery Neurology Ophthalmology Pediatrics ORL Psychiatry - general & ICU Orthopedic Surgery Psychiatry – ICU Pediatric Surgery Pulmology Plastic Surgery Rheumatology Thoracic Surgery Urological Surgery Vascular Surgery HOSPITAL BEDS AND STAFFING A number of health resource parameters are relatively low in Kosovo compared to other countries. Comparator countries for considering parameters have been discussed with the Health Services Working Group and those agreed to be potentially interesting were:  Albania, TFYR Macedonia – neighbor countries and a destination for some health care  Belgium, Ireland – geographically small, developed countries  Croatia, Slovenia – ex-Yugoslavia, reforming health systems  Italy, Germany – destination for some health care  Denmark, Finland, UK – source of major health care reform projects in Kosovo  Sweden – more socialist/welfare model  Group of older EU countries  Group of newer EU countries. Report 2: Data ______________________________________________________________________________________ 54 ____________________________________________________________________________ Kosovo Health Master Plan Again care is needed in making comparisons as indicated previously. The full range of considerations will be taken into account when selecting parameters for designing Kosovo’s health network. This will be discussed in more detail within the Expert Working Group on Planning but include:  The number of acute care hospitals in Kosovo is approximately 0.5/100,000 people Figure 1: Comparing the number of acute care hospitals in Kosovo Kosovo  The number of acute care beds in Kosovo is 180/100,000 Figure 2: Comparing the number of acute care beds in Kosovo Kosovo  The number of psychiatric beds in Kosovo is 8.6/100,000 Report 2: Data ______________________________________________________________________________________ 55 ____________________________________________________________________________ Kosovo Health Master Plan Figure 3: Comparing the number of psychiatric beds in Kosovo Kosovo  The number of specialist physicians in Kosovo is 45/100,000. Figure 4: Comparing the number of specialist physicians in Kosovo Kosovo HOSPITAL AVERAGE BED OCCUPANCY Bed occupancy measures the percentage of time a bed has a patient in it. This is not recommended to be 100% as time is needed to change from one patient to another, and there should also be the ability to cope with seasonal variation. In the Regional Hospitals the bed occupancy for the various departments is in Table 29. In the Prishtina University Center the Average Occupancy Rate tends to be higher (Table 29). Report 2: Data ______________________________________________________________________________________ 56 ____________________________________________________________________________ Kosovo Health Master Plan Table 29: Average bed occupancy rates in QKUK and range of bed occupancy in regional hospitals Department Bed Occupancy QKUK Regional Hospital Bed Occupancy Range Abdominal Surgery 70.2% Coronary Care 91.8% 40%-68.3% Cardiology 100% Endocrinology 70.4% Gastroenterology 84.9% Gynecology 87.3% 31.4% - 71.5% Intensive Care 25.8% - 61.4% Internal Medicine 40.2% - 83.5% Maxillofacial 37.7% Neonatology 35.7% - 77.1% Neonatal ICU 77.5% Nephrology 67.6% Neurology 74% 65.4% - 79.9% Neurosurgery 92.6% Neurology 74.0% Obstetrics 97.3% 39.5% - 86.8% Ophthalmology 59.3% 26.8% - 62.3% ORL 85% 22.6% - 63.0% Orthopedics 43.8% - 73.5% Orthopedic Surgery 62.5% Pediatric Surgery 63.2% Pediatrics 57.9% 29.3% - 49.9% Plastic Surgery 80.2% Psychiatry 59.6% 30.6% - 78.1% Psychiatric ICU 74% Surgery 25.9% - 69.3% Thorax / Pulmology 86.7% 57.0% - 85.1% Thoracic Surgery 105% Urological Surgery 49.6% Vascular Surgery 86.4% It is clear that day surgery is not a concept that has been adopted to any degree in Kosovo, with the vast majority of cases being more than one day. No separate day surgery units were in evidence, though of course some procedures were admitted and discharged on the same day. Some facilities put training in endoscopic surgery techniques as one of their priorities in order to reduce the necessary length of hospital stay. Report 2: Data ______________________________________________________________________________________ 57 ____________________________________________________________________________ Kosovo Health Master Plan PRIMARY HEALTH CARE STAFF Through this project we have identified 436 Primary Care facilities, 31 being classified as Main Family Health Centers (QKMF), 154 Family Health Centers (QMF), 251 Punkts (AMF). Of these we have identified to date 61 facilities catering mainly or exclusively for the Serbian population. The Integrated Mental Health Centre, 8 Community Mental Health facilities and 8 Integrated Mental Health Houses are funded separately through a line item in the MSH budget and staff numbers in primary care in municipalities do not include these facilities. In comparison to other countries primary care in Kosovo is low in regards to a number of parameters. These will be discussed in more detail in the Expert Working Groups:  The number of primary health care facilities in Kosovo is 20.3/100,000 population Figure5. The number of primary health care facilities in Kosovo Kosovo  The number of primary care physicians in Kosovo is 47/100,000 Report 2: Data ______________________________________________________________________________________ 58 ____________________________________________________________________________ Kosovo Health Master Plan Figure 6. The number of primary care physicians in Kosovo Kosovo  The number of primary care nurses in Kosovo is 138/100,000; the number of nurses overall is 260/100,000. Figure 7. The number of nurses in Kosovo Kosovo Pending further investigation, it should be noted that a number of features of the Kosovo health systems mandate caution in making comparisons with other countries:  Primary health care facilities are mainly either very large QKMFs or very small AMFs while PHC facilities in many comparison countries are of small to medium size and more uniform. Thus access times (with waiting times policies) may be more relevant measures of adequacy of the PHC network.  Most physicians and some nurses work double shifts – one in the public sector and one in the private sector – effectively substantially increasing the total number of physicians available. Report 2: Data ______________________________________________________________________________________ 59 ____________________________________________________________________________ Kosovo Health Master Plan The following tables show the total number of doctors, nurses and dentists in primary health care for each municipality. The technical, administrative and support staff are listed separately in the municipality summaries. Note that in the following table, as indicated previously Serbian health professionals may (eg in Fushe Kosovo) or may not (eg in Novoberde, Shterpce) be included in municipality estimates. Doctors and specialist doctors (except family medicine specialists - included in ‘doctors'); dentists, and specialist dentists; are both counted separately. Resident doctors are also counted separately, as they are available part time. Because sometimes they are the doctor listed as working 2 days a week in the punkts, the total count of doctors may be an overestimate in some municipalities. Table 30: Summary of doctors, nurses and dentists in municipalities Total PHC Dental Doctor/ Nurse/ Municipality employees Doctors Specialists Residents Dentists specialists Nurses 100000 100000 Decan 121 25 10 2 5 82 86.6 203.0 Dragash 98 9 5 4 1 35 34.3 100 Ferizaj 308 31 7 18 3 119 34.2 107.2 Fushe Kosove 103 24 3 8 2 43 103.9 127.7 Gjakova 351 69 4 8 32 263 70.4 228.7 Gjilan 320 56 27 160 55.8 159.4 Gllogoc 185 33 111 55 185 Gracanica 0 0 Hani I Elezit 18 4 10 40 100 Istog 126 20 6 9 67 59.1 152.3 Junik 22 2 1 1 2 10 41.7 104.2 Kacanik 105 24 1 4 65 87.8 197 Kamenice 180 13 6 1 78 40.3 157.3 Kline 138 16 8 1 1 78 56.8 177.3 Leposavic 0 0 Lipjan 270 38 4 2 4 147 60.8 212.7 Malisheve 122 15 2 53 32.7 101.9 Mamushe 8 1 1 5 16.7 83.33 Mitrovice Nth 0 0 Mitrovice 32 9 149 35.6 165.6 Novoberde 1 4 40 160 Obiliq 99 18 4 56 69.2 215.4 Report 2: Data ______________________________________________________________________________________ 60 ____________________________________________________________________________ Kosovo Health Master Plan Table 30 (continued): Summary of doctors, nurses and dentists in municipalities Total PHC Dental Doctor/ Nurse/ Municipality employees Doctors Specialists Residents Dentists specialists Nurses 100000 100000 Peje 318 44 12 16 9 159 48.7 138.3 Podujeve 246 49 19 4 124 58.1 106 Prishtina 862 194 32 23 18 367 58.2 94.45 Prizren 61 26 12 274 28.4 127.5 Rahovec 129 25 68 39.7 107.9 Shterpce 16 (A) 330(S) 1 26.0 0 Shtime 19 4 2 40 82.1 142.9 Skenderaj 176 22 2 102 42.9 182.1 Suhareke 151 25 3 7 1 107 35 133.8 Viti 55 19 3 2 2 92 51.7 198 Vushtrri 23 9 2 5 82 45.3 109.3 Zubin Potoc 0 0 Zvecan 0 0 Totals 4408 913 141 29 201 48 2950 48.55 132.7 NUMBERS AND TYPES OF UNEMPLOYED HEALTH WORKERS Each municipality was asked about the number and type of unemployed health workers in the municipality. This was to try to understand the impact on human resources of increasing or decreasing levels of employees. Table 31: Estimated unemployed health workers in municipalities Municipality All PHC sector employees Unemployed health workers Decan 121 100 nurses, 1 orthopedist, 1 GP Dragash 98 100 Nurses 3 FM specialists,, 6 dental specialists, 1 Ferizaj 308 Pediatrician, 5 GPs Fushe Kosove 103 (85 A; 18 min) FM, GP, dentist 15 GPs, dentist, vascular surgeon, plastic Gjakova 351 surgeon Gjilan 320 12 GPs, internal medicine, orthopedist Report 2: Data ______________________________________________________________________________________ 61 ____________________________________________________________________________ Kosovo Health Master Plan Table 31 (continued): Estimated unemployed health workers in municipalities Municipality All PHC sector employees Unemployed health workers Gllogoc 185 55 Gracanica Hani I Elezit 18 Nurses Istog 126 Junik 22 15 nurses Kacanik 105 1 midwife Kamenice 180 Kline 138 2 GP, 1 gynecologist Leposavic Lipjan 270 Nurses Malisheve 122 100 nurses Mamushe 8 Mitrovice Nth none Mitrovice Novoberde none Obiliq 99 20 nurses Peje 318 30 docs Podujeve (Besiane) 246 100 nurses/3 GP/1 Pediatrician Prishtina 862 at least 20 doctors Prizren 3 doctors Rahovec 129 Shterpce 16 (A) 330(S) 0 Shtime Many nurses unemployed Skenderaj 176 200 nurses Suhareke 151 100 nurses, 1 physiotherapist,1 psych Viti 55 Vushtrri 20 GPs Zubin Potoc Zvecan Report 2: Data ______________________________________________________________________________________ 62 ____________________________________________________________________________ Kosovo Health Master Plan PHARMACEUTICALS Pharmaceuticals supply was the most frequently mentioned important issue to resolve in the health system for all municipalities. The current arrangement is for the MSH to procure and distribute all the necessary drugs from the essentials drug list (EDL). The logic in taking this taking this approach is obvious in regards to the potential to negotiate better prices. It is clear however that this process is not operating well at the present time. With the possible exception of the Prishtina City Emergency Center, where the patient load is small, and the range of drugs required is less, every other facility, in all levels of care, report a massive lack of EDL drugs compared to what they need each month. The facilities consistently reported that they only receive 15-30% of the requested drugs each month. Results of examinations of records in 11 PHC facilities are in Table 32. Facilities also report issues with the drugs being close to their expiry date and sometimes receiving drugs which had not been ordered. PHC facility pharmacies had an average of 20 of the 94 of the drugs on the EDL which could be expected to be on their shelves at the time of visit. Table 32: EDL drugs requested and supplied to primary health care facilities Request provided to Received from % order QKMF Month MSH MSH received Skenderaj December 2007 74882 16437 22 Vushtrri January 2008 54992 15005 27.3 Kline March 2008 33860 2660 7.9 Junik April 2008 5135 1521 29.6 Podujeve April 2008 39047 21230 54.4 Drenas April 2008 45248 23332 51.6 April 2008 86750 7556 8.7 Dragash April 2008 48935 11928 24.4 Gjilan May 2008 49070 25705 52.4 Malisheve May 2008 45208 8901 19.7 Suhareke May 2008 15262 4240 27.8 Total 498389 138515 27.8% An inspection for a basket of 14 emergency drugs – adrenaline, atropine, penicillin, chlorpromazine, dexamethasone, diazepam, digoxin, frusemide, glyceryl trinitrate, lignocaine (or similar), metoclopramide, morphine (or similar), salbutamol, verapamil - was made during the site visits. The inspection was to see, on the particular day of the inspection, how many of the 14 drugs were present in Report 2: Data ______________________________________________________________________________________ 63 ____________________________________________________________________________ Kosovo Health Master Plan the emergency department, or even in the facility. On average in primary care facilities there were 6.8 of the 14 drugs, or 49%. In the case of the City Emergency Center 13 of the 14 drugs were present, or 93%. Table 33: Emergency drugs availability Emergency Drug % facilities having Adrenaline 91% Diazepam 78% Dexamethasone 70% Frusemide 70% Metoclopramide 70% Atropine 48% Penicillin 48% Verapamil 48% Morphine (or similar analgesic) 43% Chlorpromazine 39% Digoxin 35% Lignocaine (or similar local anaesthetic) 30% Salbutamol 26% Glyceryl trinitrate 22% Another pharmaceuticals related concern is that presently in all levels of care (including the MSH) there are only a couple of pharmacists. When planning our reviews of pharmacy departments, we had an assessment which covered the range of processes, materials and services which would be expected in a health facility pharmacy. It became apparent that the only processes in the pharmacies visited were inventory control and basic dispensing logs; the only materials were drugs and some supplies; and there were no pharmaceutical management services available. As drugs become more available this will be of increasing concern. Already there are signs of poor medicine use, such as the wide reliance on injectables and infusions. As drugs become more readily available, medication use problems will also increase. Staff interviewed believed that patients were well Report 2: Data ______________________________________________________________________________________ 64 ____________________________________________________________________________ Kosovo Health Master Plan informed about their condition – a belief that usually indicates a lack of awareness of the problems patients have managing their conditions. The overabundance of nurses for their present patient load offers the opportunity for patient education programs, and this has commenced in some facilities. In the current absence of pharmacists, training for nurses in wise use of medicines and communicating with patients about their medication management, would be a sensible investment at this stage. EQUIPMENT GENERAL Equipment - right from the most basic - is generally lacking in all levels of care. As part of the examination of primary care facilities, the staff was asked to confirm the presence of any of the following items that were identified in MSH administrative decisions as mandatory for primary care in specific circumstances. There are clearly shortages in terms of many items of primary care equipment. The results are in Table 34. Table 34: Percent of primary health care facilities having any working item Equipment % having item Equipment % having item Stethoscope 100% Growth chart 18% Sphygmomanometer 82% Ob/Gyn set 18% Sterilizer 82% Ear syringe 18% Ophthalmoscope 73% Antishock therapy 18% Otoscope 73% Oxygen 18% Refrigerator 73% Infusion set 18% Gloves 73% Torch 9% ECG 64% Height board for babies 9% Adult scales 55% Tourniquet 9% Baby scales 55% Ophthalmological set 9% Microscope 55% Snellen eye chart 9% Fetoscope 45% Urine dipstick 9% Defibrillator 45% Life support kit 9% Centrifuge 45% Autoclave 9% Photometer 45% Temporary splints 9% Report 2: Data ______________________________________________________________________________________ 65 ____________________________________________________________________________ Kosovo Health Master Plan Table 34: Percent of primary health care facilities having any working item Equipment % having item Equipment % having item Reflex Hammer 36% Doctor’s bag equipped 9% Nebulizer 36% Laryngoscope 9% Generator 36% Bandages 9% Development assessment Glucometer 27% toys 0% Peak Flow Meter 27% Glucose test strips 0% Tongue depressors 27% Fluoroscein eye strips 0% Doppler 18% ET tube 0% Thermometer 18% Nasal speculum 0% Tape measure 18% Some facilities also provided the quantity of these items. Of those items, Table 35 selects items which are basic to the practice of a primary care physician. When the number of doctors in the relevant facilities is taken into account, it can be seen that the basic equipment lack is even more concerning. Table 35: Average number of working pieces of equipment per doctor Item per doctor Item per doctor Tongue depressors 2.7 Glucose test strips 0.2 Disposable Gloves 2.7 Ophthalmological set 0. 1 Stethoscope 1.1 Ophthalmoscope 0.1 Sphygmomanometer 1.1 Otoscope 0.1 Sterile bandages 0.7 Torch with battery 0.1 Antishock therapy (adrenaline) 0.4 Growth charts 0.1 Peak flow meters 0. 2 Doctor bags with equipment 0.1 Reflex hammer 0.2 Snellen eye charts 0 Thermometer 0.2 Urine dipsticks 0 Tape measure 0.2 Small surgical kits 0 Weighing scales (adults) 0.2 Similarly in secondary and tertiary care facilities, there appears to be a general lack of essential equipment. Staff in every department cited items essential to their work which were not available, too old, or not maintained adequately enough to be relied upon. Report 2: Data ______________________________________________________________________________________ 66 ____________________________________________________________________________ Kosovo Health Master Plan LABORATORY EQUIPMENT AND XRAYS Each QKMF and many QMFs have basic laboratory equipment. The most commonly seen equipment is: Hematology Analysers: Medonic CA620 Sysmex KX21N Photometers: Clinical Chemistry Analyzers: Dialab DTN 410 Humalyzer 2000 Humalyzer Junior. The majority of equipment has been donated and there are many examples of broken equipment or new equipment that has never been used because of lack of specific reagents, or more frequently because of the price of the reagent or lack of maintenance and servicing budget. The typical equipment seen in primary care is designed as relatively low volume equipment. Some of the QKMFs are located close to regional hospitals, which also may have relatively low volume equipment. A similar situation is taking place in radiology where the choice of which XRay equipment to place in what situation appears somewhat haphazard. Some primary care facilities receive relatively sophisticated equipment even in one case a CT scanner, while the hospitals, where it would be expected that larger more comprehensive equipment is needed, receive potentially inadequate equipment. Maintenance of imaging equipment is also a problem with many examples of malfunctioning equipment lying around radiology departments. The Master Plan will outline a strategy whereby services are consolidated where possible, thereby enabling the purchase of larger volume equipment with lower overall cost, as well as a strategy to ensure appropriate maintenance of equipment. EMERGENCY VEHICLES Emergency services vehicles are organized through the primary care system and are usually located at the main family health care center. It is routine practice for the doctor to take with them the emergency pack including drugs and Report 2: Data ______________________________________________________________________________________ 67 ____________________________________________________________________________ Kosovo Health Master Plan resuscitation equipment etc, so the vehicles themselves don’t routinely contain these items. They should however contain oxygen and be suitably designed for emergency work. The ambulances and other cars based in hospitals are used to transfer cases to tertiary care in Prishtine. Some hospitals also transport dialysis patients for the municipality in which they are located. (Otherwise this is a task for the QKFM vehicles.) The site visits indicated that the lack of suitable vehicles was probably the second issue of concern, mentioned after the EDL drug supply problem. Inspections were made of quite a number of vehicles and most were donated, dated back quite a few years, and were in poor condition. See Table 36. One of the better supplied is the Prishtina City Emergency Center that provides emergency services for the Prishtina region. They have 2 donated ambulances that are in good condition, 2 in poor condition and 2 cars. This is clearly inadequate for a population of 400,000 - 500,000 people. A strategy will be developed as part of the Master Plan to address this issue. Table 36: Auto ambulances Total Functional Facility vehicles & equipped Notes about auto ambulances Gjakova Hospital 4 3 Average condition. 1 is only suitable for simple cases. Mitrovica Sth Hospital 2 2 .Both fully equipped, 1 is being serviced Prizren Hospital 4 All are 15 yrs old, in poor condition, with no equipment All old. 1 vehicle equipped for resuscitation. Plus 6 not Peje Hospital 5 5 used due to lack of documents or unpaid registration Decan QKMF 1 0 Have a minibus for dialysis transport 1 ambulance is in Bresiane; have additional car in very Dragash QKMF 3 3 bad condition to take dialysis patients to Prizren Ferizaj QKMF 4 1 3 are not equipped Fushe Kosove QKMF 2 1 Gjakova QKMF 4 3 3 are right hand drive, 2 are equipped well, 3 are new. Gjilan QKMF 2 Old not equipped; 60 transported to Prishtine/month 2 other vehicles are used to transport dialysis patients Gllogovc QKMF 3 1 (no air conditioning - 100Km/day) Hani I Elezit QKMF 2 1 Report 2: Data ______________________________________________________________________________________ 68 ____________________________________________________________________________ Kosovo Health Master Plan Table 36: Auto ambulances Total Functional Facility vehicles & equipped Notes about auto ambulances Junik FMC 1 0 Kamenica QKMF 5 2 1 vaccination car, 1 dialysis car Kline QKMF 9 2 1 is an autoambulance; 1 is a minibus for dialysis, 1 is Lipjan QKMF 3 1 not functioning Transfer cancer cases to Tirana – only can take Malisheve QKMF 9 3 maximum 5 a month; only 1 ambulance is not too old Mamushe QKMF 1 1 Not adequately equipped. Donated, so different Mitrovica QKMF 4 3 models and cannot get servicing of all vehicles 1 is in Prekovc, but only one driver who is in Novoberde QKMF 3 2 Novoberde. Obliq-Katriot QKMF 1 0 3 are ambulances; 1 car is for vaccination; 4 are for Podujeve QKMF 8 3 dialysis patient transport All are very old. Most urgent need is new minibus for dialysis transport. Don't do home visits due to lack of Rahovec QKMF 4 4 transport. 2 are used to transport patients to Beograd. All Shterpce QKMF (KS) 6 6 vehicles are 19 yrs old. Shterpce QMF (KA) 1 0 Have 1 Lada car. No emergency vehicle. Very old, difficult to maintain, and heavy fuel Suha Reke QKMF 4 4 consumption Shtime QKMF 3 1 Other 3 in bad condition - all donated 6 yrs ago. Repair expenses too high. Have another 2 cars for dialysis Skenderaj 4 1 patient transport Minibus for dialysis transport (3 hours to pick up); 6 cars too old & can't repair; 1 donated vehicle is too Viti QKMF 1 0 expensive to repair and run Vushtrri QKMF 4 2 1 is fully equipped. Report 2: Data ______________________________________________________________________________________ 69 ____________________________________________________________________________ Kosovo Health Master Plan 8. THE CURRENT NETWORK BY MUNICIPALITY Kosovo is currently divided into 34 municipalities, 3 of which are currently regarded as pilot Municipalities, with 3 proposed new municipalities. The official estimated populations3 in the current municipalities range from around 4000 (current Novo Berde) to nearly 400,000 (Prishtine). The following section briefly summarises for each municipality the facilities, staff and urgent needs. The urgent needs are those more specific to the particular municipality, and those common to all municipalities outlined previously, such as EDL drugs, service and maintenance budgets etc are not noted again here. 8.1 D ECAN Decan Municipality is bordered by Peje, Junik (pilot) and Gjakove municipalities. A border region municipality, about half of its area is a largely unoccupied mountainous region. The furthest village from the QKFM, Mazenik, is 12 km away, with a travelling time of 40 minutes by private transport due to a poor access road. There is a punkt is this village, but it is not operational due to lack of staff. Special circumstances Decan is endemic for seasonal hemorrhagic fever.4 Facilities and staff Decan has 121 staff working in a Main Family Medicine Centre (QKFM), 3 Family Medicine Centres (QMF) (Irzniq, Isniq and Strellc) and 6 punkts (AMF) (Poberj, Lumbardh, Gramaqel, Prapaqan, Prelep and Ratish), with the QKMF recording 97% of all services in the municipality. Facilities are also reported as serving some of the villages in neighbouring municipalities Peje and Gjakova. Staff comprises 27 doctors, of whom 9 are specialists, and 2 are residents; 5 dentists; 67 nurses; 10 technicians and 13 administrative and other support staff working in the QKMF. Two of the specialists (gynaecologists) and 4 of the nurses (midwives) work in the 4 bed Maternity Unit attached to the QKMF). Four of the specialists are not part of the usual PHC structure – 2 internists, otolaryngology, 3 Estimates of population are from 2008 Financing estimates 4 Kosovo has 2 types of haemorrhagic fever - Crimea Congo haemarraghic fever – a mainly tick borne disease, and Haemorrhagic fever with renal syndrome – a mainly rat carried disease Report 2: Data ______________________________________________________________________________________ 70 ____________________________________________________________________________ Kosovo Health Master Plan and dermatology. A total of 7 doctors (including 1 FM specialist); 15 nurses; and 2 technicians work in the other facilities. State of the buildings The QKMF is a relatively new building (2000) and the emergency centre is new (2008) and better equipped than other emergency centres. The buildings are well maintained and clean, however there is no central heating and a lack of proper drainage. Urgent local needs Although the emergency centre is superior, training is needed in emergency medicine, there is no equipped, functioning auto ambulance, and there is a lack of basic emergency drugs and other supplies. 8.2 DRAGASH Dragash is located in the extreme south of Kosovo and is relatively isolated, having access to the nearest hospital and specialist care, Prizren, by a long winding road (average 50 minutes drive). It is viewed as one of the poorest municipalities, with whole families (Kosovo Albanians) migrating, rather than single family members as previously. The comparatively large Gorani community (about a third of the population) is more elderly. The furthest towns from the QKMF are Restelice (4,000 inhabitants) and Zaplluxhi (2000), 25km distance (and 2 hours to Prizren). Special circumstances With long winters and poor municipality road clearing ability, some villages are isolated for days or weeks during the middle of winter, however health is reported as generally good compared with more industrial areas of Kosovo. Facilities and staff Dragash has 98 staff working in a QKFM, 3 QMF (Krushev, Llopshnik, Rapqa) and 9 AMF (Kosav, Bellobrad, Bresan, Blaq, Brod, Kuke, Radesh, Restelic, Vraniq). Staff comprises 6 doctors, of whom 2 are specialists; 3 dentists of whom 1 is a specialist; 18 nurses; 10 technicians; and 20 administrative and other support staff working in the QKMF. One of the specialists (gynaecologist) and 5 of the nurses (midwives) work in the 16 bed Maternity Unit attached to the QKMF). A total of 9 doctors (including a paediatrician); 17 nurses; 8 technicians; and 6 administrations and other support staff work in the other facilities. Report 2: Data ______________________________________________________________________________________ 71 ____________________________________________________________________________ Kosovo Health Master Plan State of the buildings The QKMF is in need of complete refurbishment, including roof replacement. Water pipes are leaking, but the leaks are difficult to find and repaired. Bresane is reported as needing a new building as the present one is falling down (not assessed by us). It was reported that buildings are otherwise in satisfactory condition except needing refurbishment, with no problems with water or drainage. Urgent local needs Because of the relative isolation and time to hospital and specialist care, it is felt a wider range of specialties are needed. The private sector is small, with just one internal medicine specialist. Although the QKFM has an XRay, if a broken bone is shown, there is nothing that can be done until the patient is transported to Prizren. There is an urgent need for improved and expanded emergency services, equipment and training. 8.3 FERIZAJ All villages except a couple in mountains are within 20-30min of the QKMF. Three new punkts have been built in Serbian villages but currently no staff attend and no patients are using the facilities. A doctor comes from elsewhere to visit patients in their homes. Facilities and staff Ferizaj has 308 staff working in primary health care which comprises a QKFM, 2 QMF (in Ferizaj) and 11 AMF (Bablak; Babushi; Gacke, Greme, Jezerce, Komogllave, Mirash, Nerodime, Softaj, Talinovci). Staff in the QKMF comprise 12 doctors, 3 are specialists other than in family medicine; 12 dentists (3 of whom are specialists); 50 nurses; 34 technicians (mainly dental) and 37 administrative and other support staff. An additional 26 doctors (of whom 4 are specialists other than family medicine); 67 nurses; 9 dentists; 25 technicians (mostly dental); and 13 administration and other support staff are located in the other facilities. In Ferizaj Municipality are also located a Hospital; an Institute for Public Health; a Community Mental Health Care facility; an Integrated House for Mental health and a TB unit with diagnostic ability. Report 2: Data ______________________________________________________________________________________ 72 ____________________________________________________________________________ Kosovo Health Master Plan The 64 bed hospital has 219 employees, including 30 doctors and 127 nurses. State of the buildings The hospital is located in one building, with 2 floors and a basement. Drains and roof are OK. They have nearly completed another building for a new dialysis unit. The hospital used to be the QKMF which was renovated, in parts, in 2001. It lacks space and some specialties and there is a proposal to build a new hospital. The drainage is adequate, but the facility needs complete refurbishment to reach standard if no new hospital is built. Urgent local needs Dentistry staff is available and they have equipment, but lack materials so can only treat small proportion of patients. There is a need for a full emergency service and a proposal has been lodged. 8.4 FUSHE KOSOVE Fushe Kosove Municipality lies on the outskirts of Prishtine toward Drenas. The furthest village from the QKMF is 20 minutes away, by both public and private transport. There has been an attempt to at least partially integrate all inhabitants, however the second floor of the QKMF allocated to Serbians patients remains unused. Facilities and staff Fushe Kosovo has 103 staff working in primary health care in the municipality, including 18 working in the parallel Serbian health system. These facilities include a QKFM, 6 QMF (Fushe Kosovo, Albane e Ma., Bardh I Madh, Kuzmin, Miradi e Ep., Miradi e Ulet)and 4 AMF (Bardh I Vogel, Gureshkabe, Livragone, Punkti ashkali). Staff comprise 18 doctors, of whom 3 are specialists, 8 are residents; a biochemist; 2 dentists; 21 nurses; 25 technicians, administrative and other support staff in the QKMF, and 9 doctors, 22 nurses and 8 support staff in the other facilities. Report 2: Data ______________________________________________________________________________________ 73 ____________________________________________________________________________ Kosovo Health Master Plan There is also an Integrated Mental Health House in Fushe Kosove. State of the buildings The building has recently been renovated well throughout by Norvac. 8.5 GJAKOVE Another municipality viewed as among the poorest in Kosovo, Gjakove borders Albania and has only 1 industry, a brick factory. A Memorandum of Understanding with Albania allows people from Albania to be treated in Gjakove when this is closer than their own health facilities. Facilities and staff Gjakove has 337 staff working in primary health care which comprises a QKFM, 10 QMF (Gjakove (3), Brogova, Cermjan, Dardani, Ereniku, Orize, Ponoshec, Skivjan)and 15 AMF (Bec, Brekoc, Danjan, Doblibare, Dol, Gergoc, Guska, Korenice, Kralan, Lipovec, Moliq, Novoselle, Sheremet, Shqiponja, Vishtazhin). Staff comprise 73 doctors, of whom 4 are specialists other than in family medicine (3 paediatricians, 1 internal medicine), and 8 are FM residents; 32 dentists, 10 dental specialists; 263 nurses; and 140 technicians, administrative and other support staff. In Gjakove Municipality are also located a Hospital; an Institute for Public Health; a Community Mental Health Care facility; an Integrated House for Mental health; and a TB unit with diagnostic ability; and an Institute of Occupational Health providing tertiary outpatient care. The 415 bed hospital has a total of 557 employees, including 64 doctors and 210 nurses. State of the buildings All PHC facilities less than 10 years old. 80% of the hospital buildings are viewed as satisfactory. They are generally clean and maintained. Report 2: Data ______________________________________________________________________________________ 74 ____________________________________________________________________________ Kosovo Health Master Plan 8.6 GJILAN Gjilan is bordered by both Serbia and Former Yugoslavia Republic of Macedonia, less than 50 km from Prishtine. Special circumstances Rural to urban migration is reported to be very significant due to destruction of villages and lack of infrastructure. Facilities and staff Gjilan has 328 staff working in primary health care which comprises a QKFM, 13 QMF (Gjilan (4), Bresalc, Cernice, Kufc e eperme, Malisheve, Miresh, Pasjan, Perlepnice, Pograghe, Zheger)and 17 AMF (Budrige, Kisha e qytetit, Kishna pole, Korotisht, Livoq I eperm, Livoq I poshtem, Llashtice, Makresh, Parallove, Partesh, Ponesh, Shillove, Shurdhan, Stanishor, Strazh, Uglar, Verbic e zhegovcit). Staff in the QKMF comprise 23 doctors; 14 dentists; 51 nurses; 10 dental technicians; 1 pharmacy technician; 9 laboratory technicians; 50 administrative and other support staff. An additional 33 doctors; 109 nurses; 13 dentists; 13 dental technicians; 8 laboratory technicians; and 10 administration and other support staff are located in the other PHC facilities. Individual facilities have population catchments of 3000 to 17000 people. In Gjakove Municipality are also located a Hospital; an Institute for Public Health; a Community Mental Health Care facility; an Integrated House for Mental health and a TB unit with diagnostic ability. The 402 bed hospital has a total of 514 employees, including 100 doctors, 17 residents, 313 nurses, and 150 technicians. State of the buildings Existing hospital buildings are mostly in need of refurbishment, with inadequate drains and water supply. We made 2 visits to this hospital - at the start and end of the visit period. The new Director has concentrated on improving hygiene and cleanliness, which was an urgent need. A number of new buildings are in process, or are finished but unequipped and unstaffed. The QKMF is old and unsuitable and larger rooms have been chopped up to gain the space needed. They have plans to add a second floor rather than build a second facility, as the building is centrally located, with a population of 40,000 within 5 minutes. However there is no parking available. Report 2: Data ______________________________________________________________________________________ 75 ____________________________________________________________________________ Kosovo Health Master Plan Urgent local needs Maintenance & refurbishing of existing hospital buildings including improvement of infrastructure (sewerage & water), especially in the maternity building. 8.7 GLLOGOC (DRENAS) Another municipality viewed as one of the poorest, Gllogoc (Drenas) is centrally located in Kosovo. Shortly there will be good road access to all villages, reducing the travelling time from the 3 furthest villages to the QKMF (which is currently 40 minutes). Forty minutes is also the travelling time to the referral hospital, Prishtine. Special circumstances Drenas has a traumatized population with chronic psychiatric illness, especially depression. There are seasonal health issues in rural areas including Hepatitis A and hemorrhagic fever. Facilities and staff Gllogovc has 185 staff working in primary health care in the municipality. These facilities include a QKMF with a 16 bed maternity unit, 5 QMF (Baice (Rezistence), Gilaneselle (Shkabe), Komoran (Bushat), Orliat (Arllat), Terstenik (Qendrese)) and 7 AMF (Abri e Eperme, Dobroshefc (Dritan), Gradice (Dodone), Terdec (Grykas), Nekofc (Nikaj), Stankofc (Flamuras), Vasileve (Paklek/Malesi)). Staff comprise 21 doctors; 91 nurses; and 40 other technicians, administrative and other support staff in the QKMF, and 11 doctors, 20 nurses; 2 laboratory technicians and 7 support staff in the other facilities. There is also an Integrated Mental Health House in Drenas. The only private facilities of interest apart from the usual private practices of the local publicly employed specialists, are 2 private surgeons in practice, one of which has some beds. State of the buildings The Integrated Mental Health House is a brand new building, staffed and waiting to commence providing services when viewed. There is a proposal to Report 2: Data ______________________________________________________________________________________ 76 ____________________________________________________________________________ Kosovo Health Master Plan build a new building for the punkt in Vasileve (Paklek/Malesi) (current building not viewed). The QKMF used to use fuel heating but found it too expensive and has reverted to coke. The roof is leaking badly and drainage is a big problem, with 3-4 toilets not functioning. Areas renovated under prior management already show signs of poor renovation. Urgent local needs There is no pulmologist in the area, with an increase in TB cases. Access to pulmology services, especially in the light of the level of new TB cases, will be set by the Project Working Groups. Emergency department improvements are needed with respect to space and equipment. 8.8 HANI I ELEZIT A small pilot municipality, Hani I Elezit is bordered by Kacanik Municipality and Macedonia. The furthest villages are 7 km from the FMC, however there is no public transport. Special circumstances Hepatitis A is a problem, with untested water associated with the local cement factory suspected of being mixed with other municipality water. Facilities and staff Hani I Elezit has 18 staff working in primary health care in the municipality. These facilities include the QMF in Hani I Elezit and 1 AMF (Gorance). Staff comprise 4 doctors; 10 nurses; 1 laboratory technician; and 2 administrative and other support staff. The FMC works only 2 shifts (7 am to 8pm - until 2pm on Saturday and Sunday) and outside of these times, people go to Kacanik for primary health care services (16 km- 15 min) or for hospital services to Ferizaj (36Km). There are no laboratory, XRay or antenatal services available in the QMF. State of the buildings The FMC building is good, well maintained and clean, except for the incinerator which needs total replacement. Urgent local needs Report 2: Data ______________________________________________________________________________________ 77 ____________________________________________________________________________ Kosovo Health Master Plan Because the minibus, which serves as the only ambulance, transports dialysis patients to Gjilan 3 days a week, on these days there is no ambulance service available for emergency cases in Hani I Elezit. A fully equipped ambulance and a 4WD vehicle for dialysis and other patient transport are needed. The QMF does not have a phone and staff lack emergency services training. 8.9 ISTOG Istog is bordered by the mountains of Montenegro and is well connected to both Peje and Mitrovice. It is a relatively healthy area apart from its highly mineralized water. However all villages now are connected to water supply. Facilities and staff Istog has 126 staff working in primary health care in the municipality. These facilities include a QKFM with a 14 bed maternity unit, 3 QMF (Gurakoc, Rakosh, Vrell)and 9 AMF (Cerkole, Dobrush, Dubrav, Kaliqan, Osojan, Saradra, Studenic, Veriq, Zaliq). Staff comprise 21 doctors, of whom 6 are specialists other than family medicine; 5 dentists; 39 nurses; and 32 technicians, administrative and other support staff in the QKMF and 5 doctors; 4 dentists; 28 nurses; and 8 support staff in the other PHC facilities. The municipality is involved in an Intersource palliative care (mainly) program where a specially trained team consisting of a doctor, nurse and driver spends 1 week in each of 4 municipalities – Kline, Peje, Decan and Istog – visiting patients in their homes. A patient education and monitoring program for diabetes, hypertension, community and infection control is also just commencing through the nursing college. State of the buildings There is a proposal to build a new QKMF as the current one (2 buildings) is 60 years old and has drainage, water and roofing problems (in danger of collapsing in 1 building), despite a number of renovations over the years. The building appears solid, but needs extensive internal and external work to bring it up to health facility level. The XRay department is up a couple of flights of stairs with no lift. Swiss Red Cross previously replaced the original coke heating, but fuel costs were 50,000E a year, so the facility has returned to the old coke heating again. Urgent local needs Mobile emergency team is needed, especially to cover hours after 3pm when only one doctor is working in the emergency department. Report 2: Data ______________________________________________________________________________________ 78 ____________________________________________________________________________ Kosovo Health Master Plan 8.10 J UNIK Junik is small pilot municipality bordered by the mountains of Albania. All villages are less than 5km from primary health care (10 minutes), and up to 30 minutes to secondary care (Peje or Gjakove), by private transport. Special circumstances The municipality reports it has higher psychiatric conditions, hypertension, and myocardial infarctions than other areas of Kosovo. Facilities and staff Junik has 22 staff working in primary health care in the municipality. These facilities include a QFM which works 2 shifts – 7am to 11pm. Staff comprise 4 doctors, 1 of whom is a family medicine specialist, 1 an ophthalmologist, and 1 a resident; 2 dentists; 10 nurses; and 6 technicians, administrative and other support staff. State of the buildings – infrastructure & maintenance The building is small and in poor state with drainage problems and no heating. Urgent local needs Vaccination services have not been fully established, with some key equipment needed, including vaccine refrigeration and logistics support. The municipality lacks a pharmacist technician. 8.11 KACANIK The main hospital for Kacanik is Ferizaj, 20 km away, a 15-30 minute drive. The furthest populated village is about 5-6 km away from the nearest punkt, and 35 km (40 minutes) away from the QKMF. One other village is only 15 km distance, but because of the road conditions, is 1 hour away from the QKMF. About 98% of the population is covered by the current primary care network. Some go to Viti when that QKMF is closer for them. Special circumstances Apart from the health conditions of concern all over Kosovo, the main health issue in Kacanik is TB patients. Report 2: Data ______________________________________________________________________________________ 79 ____________________________________________________________________________ Kosovo Health Master Plan Facilities and staff Kacanik has 105 staff working in primary health care which comprises a QKFM with a maternity unit (unofficial), 1 QMF (Kacanik te vjeter) and 8 AMF (Doganaj, Begrace, Bicaj, Gure Zi, Lisnaje, Lum Bardhe, Qafe Shqipe, Stagove). After 3pm all go the QKMF. The maternity unit does not have a gynecologist on call at night so deliveries afterhours are transported to Ferizaj. Staff comprise 25 doctors, of whom 1 is a specialist apart from family medicine (gynecologist), and 4 are FM residents; 65 nurses; and 22 technicians, administrative and other support staff. Kacanik Municipality also has a TB unit without diagnostic ability (this had not commenced operations when visited by us). State of the buildings – infrastructure & maintenance There have been partial renovations in the TB unit and emergency. The downstairs area of the building is particularly unhealthy with leaking pipes and fungal growth and plaster bubbling. The building needs refurbishing, with total roof, doors & windows, drainage, central heating. Recently renovated areas are already deteriorating in the main building. 8.12 KAMENICE Kamenice Municipality has very spread villages, however they are generally covered by primary care, except for a mountain village Policka. Special circumstances Renal problems are of concern. Facilities and staff Kamenice has 180 staff working in primary health care which comprises a QKFM and 2 QMF and 12 AMF (Busavate, Desivojce, Hogosht, Karaqeve, Kopernice, Koretine, Krileve, Lisocke, Muqiverce, Rogane, Shipashnice e Eperme, Strezovc, Topanice, Tuxhevc). In addition in the parallel Serbian facilities there are 2 QMF (Ranilug, Kamenice) and 9 AMF (Bosce, Ajnovc, Kolloleq, Ropotove, Korminjan, Domarovc, Bozhevc, Rajanov, Bushince). The Serbian population come to QKMF afterhours for laboratory and XRay. Due to the parallel health systems, some of the facilities are within 2 km of each other. Report 2: Data ______________________________________________________________________________________ 80 ____________________________________________________________________________ Kosovo Health Master Plan Staff in the Albanian facilities comprise 16 doctors, of whom 6 are specialists (1 paediatrician, 1 gynecologist, 1 internal medicine), and 3 are FM residents; 1 dentists; 78 nurses; and 23 technicians, administrative and other support staff. State of the buildings There are problems with the infrastructure of many of the punkts and QMF – 6 have no water and also have drainage problems. The QKMF consists of a number of buildings in a variety of conditions. One is in particularly bad condition with an asbestos roof, and 3 have drainage problems. Urgent local needs The main problem is old buildings with old equipment. 8.13 KLINE The QKMF in Lipjan (25000 population) is 25 km from Shale (6000); 17 km from Janjeve (5000); 15 km from Magure (8000), Gadime (10000); Babush (2000); Banulle (2000); 13 km from Dobraje (2000); 10 km from Kraishte (2000), Sllovi (4000); 6 km from Robvc (2000); 5 km Banulle(2000). Facilities and staff Kline has 138 staff working in primary health care which comprises a QKFM with maternity unit, 3 QMF (Sjerk, Ujmir, Zllakuqan) and 9 AMF (Budisallc, Cerovik, Drenoc, Gllareve, Grabanic, Jagod, Jashanic, Jashanic, Shtupel). Staff comprises 24 doctors, of whom 8 are specialists (4 paediatricians, 2 gynecologists); 1 dentists, 1 dental specialists; 78 nurses; and 37 technicians, administrative and other support staff. In Kline Municipality is also located a TB unit with diagnostic ability. State of the buildings The QKMF has recently moved into a new building, which shows signs of being poorly built, with roof already leaking. Their CT scan has been left in the old building because it is water damaged. Their fully equipped maternity unit is not operating currently, although they have midwife staff. Urgent local needs Although the emergency department has been recently renovated, it is small, dark and windowless and further renovations are commencing. Report 2: Data ______________________________________________________________________________________ 81 ____________________________________________________________________________ Kosovo Health Master Plan 8.14 LIPJAN The furthest village from the QKMF is 45 km – 1 hour travelling. This village is 8 km (30 minutes) from Shala QMF. Facilities and staff Lipjan has 270 staff working in primary health care which comprises a QKFM, 4 QMF (Magure, Shale, Gadime, Janjeve) and 6 AMF (Sllovije, Kraishe, Robovc, Babushe, Dobraje Banulle). Staff comprise 42 doctors, of whom 4 are specialists; 2 dentists, 4 dental specialists; 147 nurses; and 63 technicians, administrative and other support staff. In Lipjan Municipality is also located a TB unit without diagnostic ability. State of the buildings The QKMF consists of 3 buildings of which 2 have leaking roof problems. The floor is particularly bad and the roof is leaking in the maternity area and the toilets are a big problem. Urgent local needs Refurbishment of the building is needed and they only have 1 functioning autoambulance. 8.15 Malisheve Malisheve Municipality has the highest number of haemorrhagic fever. Malisheve contracts out its dialysis patient transport for 6000E/year for their 16 dialysis patients and is very satisfied with this decision. They supply drugs to social need cases through tenders of 10,000E/year. Facilities and staff Malisheve has 122 staff working in primary health care which comprises a QKFM with a 14 bed maternity unit, 1 QMF (Kiev)and 11 AMF (Bellanic, Ceralluk, Dragobil, Drenoc, Fshati I ri, Kavaqari, Lozic, Lumizad, Pagurush, Panoc, Terpez). Staff comprise 15 doctors; 2 dentists; 53 nurses; and 28 technicians, administrative and other support staff. Report 2: Data ______________________________________________________________________________________ 82 ____________________________________________________________________________ Kosovo Health Master Plan In Malisheve Municipality is also located a TB unit with diagnostic ability. State of the buildings The large building is in good condition. Urgent local needs XRay is nearly collapsed – staff must hold a piece of the machine during XRaying, clearly a safety issue. The QMF and Panoc punkt need connection to water supply. 8.16 Mamushe Average time to get to Prizren Hospital is 30 minutes. Special circumstances A small pilot municipality with only one doctor and one dentist. Facilities and staff Mamushe has 8 staff working in primary health care which comprises a QKFM. The QKMF can only work one shift due to lack of staff. No home visits are possible. Staff comprise 1 doctor; 1 dentist; 5 nurses; and 1 and other support staff. State of the buildings They are expecting to move shortly into their new building, although the present one is also quite good. Urgent local needs No laboratory available due to lack of trained staff, although they have a lot of new, unpacked, laboratory equipment including a fully automated haematology cell counter. 8.17 Mitrovice South There are a large number of internally displaced persons (IDP) in Mitrovice, and only 10% of patients are levied with a copayment. Most villages are within 30 minutes of Mitrovice, with the furthest punkt 35 km away (but this town has practically no people), with a travelling time of an hour or more. Special circumstances The hospital for Mitrovice Municipality before the war was north of the river. A temporary hospital since then has been established in the QKMF, with an annex built to house a number of functions including a dialysis unit. The Report 2: Data ______________________________________________________________________________________ 83 ____________________________________________________________________________ Kosovo Health Master Plan hospital and QKMF share many services including emergency, laboratory and specialist services. While waiting for the political situation to be resolved, the hospital has missed the type of donor and other investments that other hospitals have received. Facilities and staff Mitrovice Sth has 275 staff working in primary health care which comprises a QKFM, 6 QMF (Shipol, Ilirida, Tuneli I pare, Shupkofc, Sheshi I vjeter, Koshtove) and 15 AMF (Bare, Bair, Kciq, Guchafc, Fidanishte, Caber, Kodra e Minatoreve, Rashan, Zhazhe, Broboniq, Vilahi, Bajgore, Kaqanoll, Selac, Zabergje, Bistrice). Staff comprise 32 doctors, of whom 14 are family medicine specialists; 9 dentists; 149 nurses; and 171 technicians, administrative and other support staff. In addition, Mitrovice Municipality staffs and operates 3 AMFs serving people there who want to use the Kosovo health system (KA) in Leposavic, Zvecan and Zubin Potok municipalities. In Mitrovice Municipality are also located a hospital; a Community Mental Health Care facility; and an Integrated House for Mental health. The bed hospital has a total of employees, including 38 doctors and 177 nurses. State of the buildings The QKMF is an old typical multistoried building with wide corridors around a central light well, into which small hospital departments have been added, including into some corridors. It is not to standard as a health facility and is difficult to keep clean and hygienic, and there are problems with the drains. Due to its inner city location, there are access problems for the ambulances and there is no patient parking. Urgent local needs Some land and buildings have been donated and work has started on replacing the hospital in stages, with new buildings and renovations of the donated buildings. Ensuring that the secondary care needs of people in this area are met will form part of the Master Plan. 8.18 Novo Berde Novo Berde is a small municipality not far from Prishtine, which is planned to increase in size. It is regarded as one of the poorest in Kosovo. Currently separate health facilities serve KA and people in Kosovo wishing to use the Report 2: Data ______________________________________________________________________________________ 84 ____________________________________________________________________________ Kosovo Health Master Plan Serbian health system (KS). The facilities are 8 km apart, but many inhabitants do not have transport. If properly staffed the facilities would adequately cover population needs. 80% of the G&S budget is spent on transporting 2 haemodialysis patients to Gjilan. Currently this is partially covered by donations. Facilities and staff Novo Berde has 7 staff working in primary health care (plus Serbian staff) which comprises a QKFM, 3AMF (Prekov, Llabjan, Tuller). Staff in the KA facilities comprise 1 doctor; 4 nurses; and 2 support staff. State of the buildings The building has been recently renovated, although not to health care standard. Urgent local needs There are no dental services though the space is available. Laboratory services commenced recently, but no XRay services are available. The municipality has no emergency transport while the only vehicle is in Gjilan with haemodialysis patients. The QKMF has a 4WD ambulance that, if repaired, would address this need. 8.19 O BILIQ Obiliq Municipality is close to Prishtine and reports significant pollution from the ash heaps from the power station, believed to be responsible for the increases in cancer in the municipality. Facilities and staff Obiliq has 99 staff working in primary health care which comprises a QKFM, 1 QMF (Mllosheve)and 4 AMF (Breznice, Palaj, Shipitull, Siboc). Staff comprise 18 doctors; 4 dentists; 56 nurses; and 22 technicians, administrative and other support staff. State of the buildings The building was renovated this year and has heating and airconditioning with generator, serving some parts of the building. However poor drainage has caused one toilet to be closed, and the roof leaks in the annex which was renovated in 2006. Urgent local needs Need 2 ambulances (1 they have is not fully equipped & functioning) Report 2: Data ______________________________________________________________________________________ 85 ____________________________________________________________________________ Kosovo Health Master Plan 8.20 PEJE Peje is a large municipality on the western side of Kosovo, bordered by mountains leading to Montenegro. Facilities and staff Peje has 318 staff working in primary health care which comprises a QKFM, 7 QMF (Peje (5), Radavc, Vitoramic, Zahaq) along with an Emergency Center, a Mother & Child Center, Paediatrician Center, Dental Center) and 17 AMF (Raushiq, Loxhe, Baran, Leshan, Poqeste, Trestenik, Ozrim, Trebovi, Doberdo, Cryshec, Kryshec, Gllogjan, Novosell, Tenic, Drelaj, Gorazhd, Haxaj). Staff comprises 11 doctors, of whom 2 are specialists (1 gynecologist, 1 other); 1 dentists; 9 nurses, of whom 2 are midwives; and 9 technicians, administrative and other support staff; and in the other facilities 70 doctors, of whom 11 are specialists (9 paediatricians, 1 gynecologist); 139 nurses (including 4 midwives); 24 dentists, of whom 9 are specialists; and 47 others. In Peje Municipality are also located a Hospital; an Institute for Public Health; a Community Mental Health Care facility; an Integrated House for Mental health; and a TB unit with diagnostic ability. The 448 bed hospital has a total of 557 employees, including 105 doctors, 4 residents, and 299 nurses. State of the buildings The QKFM has been moved to a fairly isolated location away from the centre of the city, unsuitable for the main primary care service, leaving some parts of the primary care (mother and child with paediatricians) in the city centre. The hospital has 6 separate buildings which are in basically good condition, except for one with drainage problems. Needing renovation in some parts. Urgent local needs Rationalisation of the primary care buildings, with improvement of locations. 8.21 P ODUJEVE Podujeve Municipality is on the eastern edge of Kosovo, bordered by Serbia. The settlements are within 30 minutes of the QKMF. Special circumstances They have been contemplating contracting out cleaning services and employing professional staff with the money saved. They are working in a Report 2: Data ______________________________________________________________________________________ 86 ____________________________________________________________________________ Kosovo Health Master Plan project to develop primary care protocols in hypertension, diabetes, acute otitis media, and conjunctivitis. Facilities and staff Podujeve Municipality has 246 staff working in primary health care which comprises a QKFM with a 6 bed maternity unit, 14 QMF (Lluzhan, Kerpimeh, Podujeva 2, Gllamnik, Bradash, Bajqin, Orllan, Majac, Pollat, Batllav, Halabak, Sfecel, Shajkovc, Llapashtic)and 7 AMF (Dumnic, Dobratin, Dyz, Murgull, Lupc i poshtem, Livadic (Livadhishe), Hertice). Staff comprises 59 doctors, of whom 10 are specialists other than family medicine (1 internal medicine, 1 ophthalmologist, 2 pulmologists, dermatoveneralogist, psychiatrist, radiologist, gynecologist, epidemiologist); 4 dentists; 124 nurses; and 69 technicians, administrative and other support staff. In Podujeve Municipality are also located a Community Mental Health Care facility and a TB unit with diagnostic ability. State of the buildings There are 4 buildings - a large polyclinic building, renovated and in good condition; a new building for an emergency centre which they are equipping (they have not moved into at the time of the visit); an old administration building which includes the maternity unity, in fairly poor condition; family medicine and dentistry building fairly recently renovated but in fairly poor condition. Drainage and leaking water pipes are the main problem. Urgent local needs Renovation of drainage and improving water quality. 8.22 P RISHTINE Prishtine Municipality surrounds the capital city and has the largest population. Special circumstances QKUK is the only general hospital in the area. This, combined with a relatively weak primary care sector, means that many patients turn up at the hospital with conditions that would more appropriately be handled within the secondary care or primary care environment. Seven of the top 10 conditions treated at QKUK are Ambulatory care Sensitive Conditions, in other words for conditions that in most cases should be effectively prevented or handled with primary care. This puts an enormous strain on the facility and in an Report 2: Data ______________________________________________________________________________________ 87 ____________________________________________________________________________ Kosovo Health Master Plan environment where the maintenance budget is quite limited, it quickly results in unacceptable levels of maintenance and cleanliness. The Municipality has recently announced approval for the building of 4 new QMFs. Facilities and staff Prishtine has 832 staff working in primary health care which comprises a QKFM, 15 QMF (Prishtine (6), Besi, Hajvali, Keqekoll, Kishnice, llukar, Matiqan, Mramor, Rimanisht, Shkabaj, Sliviv), a dental clinic, a City Emergency Centre (CEC), and 7 AMF (Bardhosh, Barilev, Bullaj, Flotacion, Koliq, Shashkovc, Viti). Staff comprises 226 doctors, of whom 32 are specialists (3 emergency; 2 psychiatrists; rheumatologist, 14 dermatologists; 4 pulmologists; hygienist; 8 occupational medicine; 23 dentists, 18 dental specialists; 367 nurses; and 259 technicians, administrative and other support staff. Prishtine Municipality also has a Hospital; the National Institute for Public Health; a Community Mental Health Care facility; and a TB unit with diagnostic ability. The 1931 bed hospital serving the Prishtine municipality, Prishtina University Clinical Center (QKUK) is also the tertiary referral center for the whole of Kosovo. There is no separate secondary care hospital. It has a total of employees, including 576 doctors and 1084 nurses. State of the buildings The 3 storey QKMF is in good condition except in the XRay and laboratory areas which have damaged floors. A relatively high patient load at QKUK compared to the Regional Hospitals, combined with the poor maintenance of the facilities, results in the hospital being in poor shape in regard to hygiene and cleanliness. There are differences however in this regard between departments, which may in part be due to the fact that some buildings are in particularly poor condition in terms of infrastructure, and in part because of variation in management capability between departments. All hospital buildings suffer to a greater or lesser degree from poor maintenance, but some buildings are probably beyond repair eg the General Psychiatry/Neurology building. Other buildings appear basically sound, such as Pediatrics, but would require extensive internal renovation to bring them up to a basic standard. There are also some examples of relatively recent constructions, where there is doubt about the quality of the construction and suitability for its intended purpose, such as the Oncology building. In some buildings, eg Psychiatric ICU, the recent construction appears to have been of acceptable standard. Report 2: Data ______________________________________________________________________________________ 88 ____________________________________________________________________________ Kosovo Health Master Plan The Emergency Center is one of the busiest areas of the hospital and as a result is in relatively poor shape, both in terms of equipment and infrastructure. Prishtina City Emergency Center This is a relatively new facility located close to the University Clinical Center and is the primary source of emergency services in the Municipality of Prishtina coordinated by a call center for auto ambulances within the City Emergency Center. The building is well designed and in excellent condition, as well as being well supplied with equipment and drugs. It operates 24 hours per day and provided services to 138,000 people in the last 12 months. The service includes 10 teams, comprising a doctor, a nurse and a driver, with two teams being on call at any one time. There are however a number of issues that limit the service’s effectiveness. While there are 12 vehicles at the center, there are only 2 fully equipped auto- ambulances that are suitable for this type of service. These vehicles were donated from Japan several years ago. In addition there are two less equipped but functional auto ambulances as well as one Toyota 4X4 and a Lada Niva. This appears to be inadequate for population. An additional issue is the interaction of the City Emergency Center with the Emergency Center at the University Clinical Center, which is located a short distance away. Entrance to the University Emergency Center should be by referral whereas the City Emergency Center is a primary care facility, so requires no referral. In reality the majority of patients prefer to go directly to the University Emergency without referral, presumably because of the availability of specialists. This leads to the unsatisfactory situation where the University Emergency is overloaded and in very poor condition, and with poor availability of equipment and drugs, while the City Emergency next door is fully equipped but underutilized. The location and function of the Emergency Services, including the number and location of the emergency vehicles and also the rationalization or consolidation of the existing emergency facilities will be a specific strategy developed in the Master Plan. This strategy will also deal specifically with the issue of associated activities such as laboratory services, radiology support services and the proximity to suitable operating theatres. Report 2: Data ______________________________________________________________________________________ 89 ____________________________________________________________________________ Kosovo Health Master Plan 8.23 PRIZREN Prizren is a large municipality towards the south of Kosovo. Its health conditions other than those common to all Kosovo are higher breast cancer and seasonal brucellosis and haemorrhagic fever. Facilities and staff Prizren has staff working in primary health care which comprises a QKFM, 11 QMF (1 in Prizren, Gjonaj, Hoqe e qytetit, Korishe, Lakuriq, Pirane, Ralin, Reqan, Romaje, Zhur) and 20 AMF (Arbane, Dardani, Granqoar, Jabllanice, Kushmine I Hasit, Libeqeve, Lubinje e poshtme, Lubishte e Prizrenit, Lubna e eperme, Lugishte Has, Manastirice, Mushnikove, Nashec, Planej, Skorobishte, Strugje, Veleshe, Vllashnje, Zym Has). Staff comprise 61 doctors; 26 dentists, 12 dental specialists; 274 nurses; and 57 technicians, administrative and other support staff. In Prizren Municipality are also located a Hospital; an Institute for Public Health; a Community Mental Health Care facility; an Integrated House for Mental health; and a TB unit with diagnostic ability. The 578 bed hospital has a total of 759 employees, including 160 doctors and 399 nurses. Security guards and kitchen staff have been outsourced, resulting in savings. State of the buildings Part of the hospital is a new building but back stairs, and the new part of the building are unmaintained with incomplete cleaning and broken windows and tiles, on its way to become unmaintained. More than 95% of the equipment in the hospital is working, being maintained by their own trained engineers. Calibration provided by outside firms, however the qualifications of firms in Kosovo providing calibration was questioned. The hospital has a fully equipped physiotherapy department seeing 120-130 patients/day, with a waiting list of 2-3 weeks. A conference and retail centre is planned to be started this year, financed by in- advance rents from retailers. Urgent local needs Training in Diabetes management is needed and also diabetes screening. Report 2: Data ______________________________________________________________________________________ 90 ____________________________________________________________________________ Kosovo Health Master Plan No mammography is presently available in Prizren, though they have a radiologist trained. They have most of the equipment for endoscopic surgery which would allow reduction in length of hospital stays, but staff lack training. 8.24 RAHOVEC The furthest village from the QKMF is Mrasor – 42 km away – 1 hour by car. 70% of the population lives in villages and 30% in the city, but there is a good PHC network and due to good infrastructure, access is satisfactory. Special circumstances Rahovec claims a lower unemployment rate than other municipalities due to a large organized private agricultural industry, including wine. There is a high level of renal failure and the cases of hemorrhagic fever are the highest after Malisheve. Facilities and staff Rahovec has 129 staff working in primary health care which comprises a QKFM with a maternity unit, 4 QMF (Fortes, Krusha e Madhe, Qifllak, Ratkoc)and 3 AMF (Drenoc, Hoxha e madhe, Lagja veriore Rahovec). Staff comprise 19 doctors; 47 nurses; and 34 technicians, administrative and other support staff working in the QKMF, and 6 doctors; 21 nurses; and 7 technicians and other support staff working in the other PHC facilities. A gynaecologist and midwives work in the 16 bed Maternity Unit attached to the QKMF). Rahovec Municipality also has a TB unit without diagnostic ability. State of the buildings The QKMF has 3 usable buildings and a number of buildings which need to be demolished. Two are in poor condition and one, housing XRay and Emergency Department, is new. They have a contrast-capable XRay, but no radiologist and the emergency centre has no equipment. Urgent local needs A number of buildings need to be demolished, and the main building needs complete refurbishment. After refurbishment, and redesign, there would be enough space to house the functions currently housed in the third building. The second building has very poor drains and is built close to a cliff face and renovating this poorly sited building is questionable. Report 2: Data ______________________________________________________________________________________ 91 ____________________________________________________________________________ Kosovo Health Master Plan There is no psychiatric service in Rahovec and no suitable transport to Gjakova for disturbed patients. 8.25 SHTIME Shtime Municipality is 20 minutes from Prishtine (depending on the time of day). Facilities and staff Shtime has staff working in primary health care which comprises a QKFM, a QMF (Muzeqine) and 2 AMF (Petrove, Pjetershtice). Staff comprises 19 doctors, of whom 4 are specialists (2 paediatricians, 2 internal medicine); 2 dentists; 40 nurses; and 18 technicians, administrative and other support staff. State of the buildings The QKMF is satisfied with the renovation of their building of 2007 and rate the building as excellent, with airconditioning in emergency, laboratory and dentistry. Urgent local needs Have only 1 functioning equipped autoambulance. Integrated Centre for Mental Health The Integrated Center for Mental Health is located in Shtime. It serves the whole of Kosovo and has 62 long stay psychiatric patients. No new patients have been admitted for some time. There is a total of 40 staff of which 12 are general nurses. The only doctor is the Director of the facility (previously a psychiatrist, the new Director is a family medicine specialist.) As a health care facility in general, and as a psychiatric facility, the care provided is very inadequate. There are numerous inadequacies but the more obvious ones are:  A limited review of medications prescribed and dispensed suggests that over 90% of prescribed drugs are not available and therefore not dispensed, as these patients usually do not have family members who can buy medications privately  There indications that patients may not be reviewed regularly with regard to their general medical health  Heating is inadequate and there is no operational backup generator  The bedding is inadequate or non existent Report 2: Data ______________________________________________________________________________________ 92 ____________________________________________________________________________ Kosovo Health Master Plan  There are very little or no daily activities for the patients, such as television, books, board games, external trips etc  Inadequate and unreliable transportation in the event of medical emergencies. The situation at this facility has been obvious since investigations in 2000, 2001 and 2002, however the same items of concern continue. The patients should be transferred immediately to other facilities as an interim solution. A longer term strategy for mental health and how best to utilize the current facility will be developed as part of the Master Plan. State of the building The Centre comprises a single structure with 3 floors and a basement, the exterior of which is in reasonably good overall condition. The interior however is not in good condition and would need significant work to raise it to a reasonable standard. There are signs of leaking drains and the toilets are in extremely poor condition. 8.26 SKENDERAJ Again thought to be one of the poorest municipalities in Kosovo with high unemployment. Mitrovice used to be the referral hospital, however now all emergency cases go to Prishtine, with some going to Vushtrri, where people have been satisfied with the service. Facilities and staff Skenderaj has 176 staff working in primary health care which comprises a QKFM with a 15 bed Maternity Unit, 5 QMF (Likoc, Prekaz I eperm, Qirez, Runik, Turiqec) and 8 AMF (Aqareve, Izbice, Kline e eperme, Kllodernice, Llaushe, Polac, Qubrel, Rezall). Staff comprises 20 doctors (including 2 gynecologists working in the maternity unit); 5 dentists; 78 nurses; 10 technicians and 31 administrative and other support staff working in the QKMF. A total of 4 doctors; 34 nurses; and 8 support staff work in the other facilities. In Skenderaj Municipality is also a TB unit with diagnostic ability. State of the buildings – infrastructure & maintenance The building, from 1970, was partly renovated in 2006, but this was but poorly done and the internal wall plastering is already flaking and pipes are leaking. They use coke heating due to the cost of fuel and their generator old. Report 2: Data ______________________________________________________________________________________ 93 ____________________________________________________________________________ Kosovo Health Master Plan The water supply is poor. The building has a reservoir, but no pipes to distribute water from it. Urgent local needs They are having trouble getting an additional Family Medicine specialist as they are 55 km from Prishtine and fuel is no longer covered. Due to the relatively long travelling time to secondary care, an increased range of services, especially in emergency care, are needed. 8.27 SHTERPCE Shterpce is a mostly mountainous municipality bordered by Macedonia. Its population is estimated to be 35% being Kosovo Albanian and 65% Kosovo Serbian. Roads are not generally good, with worsening access problems during winter. Special circumstances Shterpce highlights the health care problems that can occur when multiethnic communities in Kosovo are not well integrated. Not only does the level of health care services that is available to the communities differ, but there is also inevitable duplication of services and wastage. Facilities and staff All the population can in theory access any of the facilities and in certain circumstances do, however in the normal course of events the Serbian community choose to access any of the 35 Serbian doctors located at the QKMF, 7 AMF and one multiethnic QMF. The KA has access to 1 doctor (total of 16 health sector employees) shared between one AMF and one multiethnic QMF. The Kosovo Serbian population also has access to 6 auto ambulances. The KA has access to one vehicle. KA dialysis patients are transported to Gjilan Hospital for dialysis using the only official vehicle, thereby leaving the remainder of the population without access to emergency transportation on 3 days a week. KA patients requiring laboratory tests or Xrays are usually sent to Ferizaj Regional Hospital, although it is possible for them to undertake such tests at the QKMF. The KS, while they appear to have greater access to medical personnel and facilities, also have some difficulties, particularly if they require to be transferred to a higher level of care. Dialysis patients for example usually chose to go to Belgrade (or sometimes Nth Mitrovice), tying up the auto ambulances for a considerable period of time. Report 2: Data ______________________________________________________________________________________ 94 ____________________________________________________________________________ Kosovo Health Master Plan There are also differences in the availability of pharmaceuticals. The Serbian facilities receive their drugs from Belgrade and report no systematic difficulties in supply, whereas the Albanian facilities suffer from the medication supply shortages that have been reported throughout Kosovo. The salaries of the health workers are also dramatically different between the sectors. State of the buildings The multiethnic QMF is small but in reasonable condition. The punkt serving KA is the only public building in its village and is used for many purposes other than as a health facility. There are some drainage problems but otherwise is reasonable. Urgent local needs Equipped autoambulance for emergency response and transport. 8.28 SUHA REKE One QMF is 10 km away – 30 minutes travelling time – but the rest are within 5 km of Suha Reke. Diabetes and hypertension are increasing and Kasterc, Nishor, and Mushtishi have some chronic nephritis. The referral hospital, Prizren, is 20 km distance. There are no specialists or mental health care center in Suha Reke. Facilities and staff Suha Reke has 151 staff working in primary health care which comprises a QKFM with Maternity Unit, 3 QMF (Gjinoc, Mushtischt, Studencan)and 7 AMF (Bukosh, Duhel, Drejkoc, Mohlan, Nishor, Samdregje, Sopi). Staff comprises 21 doctors, of whom 3 are specialists other than in family medicine (including a pediatrician and a gynecologist); 8 dentists, including 1 dental specialist; 80 nurses, including 13 midwives; 19 technicians and 15 administrative and other support staff working in the QKMF. A total of 7 doctors; 5 dentists; 27 nurses; and 10 support staff work in the other facilities. State of the buildings – infrastructure & maintenance The laboratory and XRay areas have been inspected by occupational health and apparently assessed as too small for safe work. The vaccination center is accessed past areas of ill patients and a separate entrance is needed. This applies to other centres as well. Pipes are leaking. Urgent local needs Report 2: Data ______________________________________________________________________________________ 95 ____________________________________________________________________________ Kosovo Health Master Plan They have requested training in emergency medicine; family medicine; diabetes management; hypertension; and respiratory diseases, as they wish to prioritise prevention activities. There is a large need for mental health care in the municipality 8.29 VITI Again Viti is described as the poorest municipality in Kosovo. There are 47 villages, with 14 km from the furthest village to the QKMF and 20 km to Gjilan Hospital. There is endemic Balkan nephropathy. As there is no screening, it is likely that there are more cases than known about. Transporting patients for dialysis is a load on the municipality, with a 3 hour collection and 3 hour drop off, three times a week. Viti QKMF used to have a mental health centre, but now patients go to Gjilan, and there is no coordination of care with the QKMF. Facilities and staff Viti has 55 staff working in primary health care which comprises a QKFM, and 14 AMFs (Begunc, Debelldeh, Gjylekar, Kllokot, Letnic, Pozheran, Remnik, Sadovin, Sllatin, Smir, Stubell, Terpez, Verbovc, Zhiti). Staff comprises 12 doctors, of whom 3 are residents; 2 dentists; 61 nurses; 4 technicians and 20 administrative and other support staff working in the QKMF. A total of 9 doctors (including 2 residents); 31 nurses; and 3 technicians and support staff work in the other facilities. State of the buildings – infrastructure & maintenance 6 punkts need renovation – 1 in Pozheran (10,000 people) is an annex to police station. The main building is the typical many floors with central light well, large building. Both QKMF buildings need renovation especially the doors and windows in the main QKMF, as heating inefficient (50% goes on heating). Urgent local needs The emergency department is in very poor condition and is cramped and lacking equipment. It could be moved to the vaccination building where there is space, if the leaking roof and resulting damage was repaired. 8.30 VUSHTRRI The town of Vushtrri is located 10-15 minutes away from Mitrovice. Report 2: Data ______________________________________________________________________________________ 96 ____________________________________________________________________________ Kosovo Health Master Plan Facilities and staff Vushtrri has staff working in primary health care which comprises a QKFM, 5 QMF (Lumi Bardh, Maxhunaj, Smrekonice, Novolan, Pantine) and 7 AMF (Dumnice, Druar, Dubofc, Samadrexhe, Ashlan, Strofc, Ceceli). Staff comprise 25 doctors, of whom 3 are specialists other than in family medicine (paediatrician, biochemist and 1 other; 5 dentists, including 1 specialist; 121 nurses; 7 technicians and 17 administrative and other support staff working in the QKMF. A total of 14 doctors; and 35 nurses work in the other facilities. In Vushtrri Municipality are also located a Hospital which has 78 beds and a total of 123 employees, including 20 doctors and 75 nurses and technicians. The QKMF and the hospital are co located and share laboratory, XRay, emergency, paediatric and dental services (located within the hospital, with staff and supplies coming from both facilities. State of the buildings The QKMF was built 2 years ago in the grounds of the hospital. However it was not built to health facility standards, with narrow corridors and small consulting rooms. All QMF are in rural areas and have very little in them. They were all renovated after the war by various donors but can’t be properly maintained. The hospital used to be the QKMF and it has been renovated and equipped by UAE. It was completed in 2003 and the last renovations (roof) were in 2006, however the roof is still leaking over the kitchen and laundry. Drains, water, airconditioning and central heating are all OK. Urgent local needs If the hospital had more staff, it could admit more people. Staff currently has to do double shifts and deal with more patients than is standard practice. Report 2: Data ______________________________________________________________________________________ 97 ____________________________________________________________________________ Kosovo Health Master Plan 9. NEXT STEPS 1 CONTINUE GATHERING INFORMATION Facilities are being asked to fill data gaps to the extent they can, and are being asked to confirm data when the sources have varied. The process of conducting interviews and site visits will continue as issues arise that need to be investigated in detail. Full data about the developing parallel Serbian health care system in Kosovo has not yet been fully collected. This collection will also continue. 2 EXPERT WORKING GROUPS AND WORKSHOP A number of expert Working Groups have been established and have commenced deliberations about health priority areas, health services and equipment. It is planned to hold a Workshop in August/September to explore Kosovo’s health network parameters. Once these activities have resulted in a set of health priorities and planning parameters for the health care network, the Investment Plan Working Group will commence their deliberations. 3 PRESENT GIS DATA TO THE WORKING GROUPS In order to assess the impact of potential changes on the operation of the health network, it is useful to present the information in the form of GIS maps. Work is already underway to gather the data necessary to compile such maps. Separate maps will be compiled for each of the significant aspects of the network, such as specialty bed numbers, staff numbers and major equipment location. The impact of changing the location of particular elements of the network can be visualized through the GIS maps. The main use of the GIS will be to assist the various expert Working Groups in making their decisions. 4 PREPARE SEVERAL ALTERNATIVE NETWORK OPTIONS FOR DISCUSSION Following the agreement within the Working Group on the choice and level of each of the planning parameters, then a reconfigured network will be designed based on these parameters. As there are often multiple ways to achieve a similar objective, it is possible that several alternative options will be developed and presented to the Working Group and on to the Permanent Secretary of the MSH. 5 DEVELOP IMPLEMENTATION PLAN FOR PREFERRED NETWORK After the development of the various network scenarios, it is anticipated that discussions will then follow on the merits of different approaches. After a Report 2: Data ______________________________________________________________________________________ 98 ____________________________________________________________________________ Kosovo Health Master Plan decision has been made on the preferred model, a detailed implementation plan will be developed which will describe at facility level the changes that will need to be made to achieve the new network. 6 PREPARE CAPITAL INVESTMENT PRIORITY LIST An important aspect of the reconfiguration strategy will be the listing of the major changes that need to be made to existing facilities. This is where the inventory that has been developed in each facility will become essential. A capital investment list will be developed through this project that will assist the MSH and MEF in deciding which of the many capital investment applications they receive, are consistent with the reconfigured network, and the relative priority of each. 7 MONITORING AND EVALUATION PLAN During the various interviews conducted as part of the project to date it is clear that all facilities are routinely gathering a considerable quantity of detailed information on the services they provide and their inventory. It appears however that they are not all consistent in format, meaning that it is unlikely that this information is being used to maximum benefit. A number of centrally designed structures are in place that could be used as the basis or an effective monitoring and evaluation program. One of the outputs of this project will be a suggested process for gathering data from facilities in a consistent format and suggestions as to how that information can be used. Report 2: Data ______________________________________________________________________________________ 99 ____________________________________________________________________________ Kosovo Health Master Plan APPENDIX I – P EOPLE INTERVIEWED DURING DATA COLLECTION Permanent Secretary MSH - Ilir Rrecaj Deputy Minister of Health - Mybera Mustafa Fatime Qosaj – Adviser MSH personnel Ismet Abdullahu – Shef Mental Health Arsim Qavdarbasha - Dir Health Pashk Buzhala – Shef Public Health Commissioning Agency Hazbija Fazliu - Shef Minorities Kadrije Ratkoceri CPD Board Curr Gjocaj – Head Health Services Haki Sfishta - Finance Department Valdet Hashani – Head PHC Njazi Shala – Shef Reproductive & Maternal Fetije Huruglica - Shef Nursing Division Health Ismet Hyseni – Shef Procurement Xhevat Ukaj – Shef HIS Zef Komoni – Health Inspectorate Genc Ymerhalili - Head Centre for Family Nexhdet Kondirolli - Director Dept Pharmacy Medicine Iljaz Miftari – Shef HR Division Ilirian Zymberaj – Sanitary Inspectorate Arberesha Turjaka – Projects Coordination Health Master Plan Project Working Groups Health Services Working Group: Health Priorities Working Group: Chairman: Curr Gjocaj Chairman: Naser Ramadani Sevdije Bajraliu Pashk Buzhala Basri Lenjani Ymer Elezi Teuta Qilerxhiu Njazi Shala Drita Fazliu Luan Jaha Shemsedin Dreshaj Agron Kasumi Sami Spahiu Majlinda Gjocaj Other Agencies Valbona Bogujevci Department for International Development Naim Kelmendi, Ministry of Transport, Head of GIS Les Cheesman- Team Leader Transport Planning Strategy Bashkim Bellaqa – Statistics Organization of Kosovo Kadri Sojeva Director Department Population Statistics Naser Ramadani Director National IPH Merita Berisha – Head IT Strategy Committee, NIPH Nexhat Krasniqi - Director Dept HIS & Medical Statistics NIPH Petrit Popova – Ministry of Economy & Finance, MSH Budget Agim Krasniqi MEF Sarah Horrigan USAID at MEF Skender Syla; Tom Judd; Andre Issakov – World Health Organisation Kaisa Rouvenin - Finnish Liaison Office Peter Swinson – MSH Strategic Plan consultant Report 2: Data ______________________________________________________________________________________ 100 ____________________________________________________________________________ Kosovo Health Master Plan Decan Municipality Selmon Berisha Decan QKMF Maternity Unit Haki Shehaj – Director Staff Xhemajl Latifaj – Finance Laboratory staff: Gjyle Berisha; Rrustem Elezaj; Maliq Tishukaj Dragash Municipality Ramadan Jashari Dragash MFMC Maternity Unit Raif Shala – Director F Bojaxhiu – gynecologist Mstan Sadiki – emergency dept Badushe Bajraktari - midwife Shazi Bajrami – xray tech Agim Dauti – biologist Xhevahire Bojaxhiu - laboratory technician Adile Kurtishi – Pharmacy technician Ferizaj Municipality Director Health & Social Services- Bashkim Hyseni Ferizaj Hospital Director- Sylejman Metushi Ferizaj QKMF Head of Nursing – Ymer Llabjani Medical Director – Sevdije Bajraliu Chief Dentist Afrim Abazi Director – Ganimete Bajrami Dentistry staff Admin – Agim Rexhaj Pharmacy staff Head Nurse – Dauti Derguti Chief Paediatrician Laboratory staff Obstetrics Department staff Vaccination Unit staff Surgery Department staff Radiology and pulmology staff Emergency Department staff Fushe Kosove Municipality Director Health & SW – Nurije Avdiu Fushove Kosove QKMF Ali Prebreza Nursing staff Laboratory Technician Family Medicine Specialist Gjilan Municipality Director Health & Social Welfare - Maxhide Shaqiri Gjilan MFMC Gjilan Hospital Salihe Mustafa – Director Director - Xhavit Hajdari Head Nurse Zijadin Hasani – manager Deputy Manager - Nexhat Halili Head Emergency dept IT Department staff Head of Nursing – Sevdije Jashari Ramadani Zejdush Tahiri – Head Emergency Pediatrician Hajriz Shaqiri – Chief of Family Medicine Laboratory staff Pharmcy technicians: Selvete Mahmuti; Emergency Department staff Adile Sylejmani Radiology staff Report 2: Data ______________________________________________________________________________________ 101 ____________________________________________________________________________ Kosovo Health Master Plan Laboratory staff including Sebahate Hasani Xhevdet Latifi – Pulmologist & Dialysis Unit staff Gynaecologist & Maternity Department staff Gjakova municipality Kriste Deda – Director Health & Social Welfare Gjakova MFMC Gjakova Hospital Yllzim Dyla – Director Haxhi Kamberi – Director Hektor Binishi – Family Medicine Dept Head Medical Director Head dentistry Xhafer Xhiha Burim Gojani – councilor FM Drenac (Gllogoc) Municipality Ilmi Dobra - Director H&SW Drenas QKMF Integrated House Gani Halilaj – Dire ctor Mirdita Leku; Sofa Hamza; Aferdita Krasniqi; Emergency Dept staff – Sheremet Hasi; Hysni Neziri Xhavit Hamza XRay technician – Daut Gjinovci Lab staff incl Rexhep Kastrati; Qerkin Berisha; Maternity Unit Musa Shala Gynecologist – Jakup Dobra Pharmacy techs – Sherife Aliu; Arjana Gjinovci Midwives including Shpresa Ajazi Gracinice Municipality Gracinice Hospital Paediatric surgeon – Dr. Dragan Peric Hani Elezit Pilot Municipality Director Health& SW – Sear Dernjani Hani I Elezit QMF Menduh Kaloshi Isa Berisha Medical and dental staff Istog (Burim) Municipality Januz Januzaj – Director Health & SW Brahim Hetemi – health budget Istog QKMF Maternity Unit Anton Gega – Director Cele Aliaj - Gynecologist Rifat Idrizaj – economoist Midwives Sevdije Shabanaj – quality coordinator Mexhide Ymeraj – head nurse Sabrije Blakaj – lawyer Ekrem Berisha – emergency department Teuta Kukleci;Lule Berisha – emergency nurses Shaban Bajraktari – XRay technician Aferdita Xhuraj – Laboratory technician Junik Pilot Municipality Report 2: Data ______________________________________________________________________________________ 102 ____________________________________________________________________________ Kosovo Health Master Plan Director Health&SW – Ali Kuqi Junik QMF Rexhe Gjocaj & Nursing staff Kacanik Municipality Director Health & SW – Misim Sopa Kacanik QKMF Maternity unit Director - Nejazi Luma staff including Filkizare Dema Nezafete Avdiu Isa Berisha Emergency department staff including Dashurie Gashi Dental department staff Kamenica Municipality Director H&SW – Nebi Sylejmani Kamenica MFMC Maternity Unit Director – Rizah Hoda Gynaecologist – Zeqir Gerbeshi Nafije Ajvazi – head nurse Midwife Quality coord – Asllan Dermaku Emergency dept staff Internal medicine – Muhamet Dermaku Epidemiologist – Njazi Hoda & Vacc nurse Laboratory staff Kline Municipality Director Health & SW – Palush Prenaj Kline QKMF Director – Dr. Ali Ahmetxhekaj Head Nurse Pharmacy Technician Emergency Department staff Lipjan Municipality Director H&SW – Banush Gashi Lipjan QKMF Maternity Unit Director - Naim Avdiu Staff Malisheve Municipality Skender Hoti – Director H&SW Malisheve QKMF Maternity Unit Aziz Thaqi – Director Abaz Morina – gynecologist Shefqet Pacarizi – quality coordinator Rukije Shala - midwife Besnik Krasniqi – Emergency head tech Hysen Mazreku; Besim Morina – XRay tech Burim Thaqi – lab technician Vezire Buqaj Mazreku – dentist Report 2: Data ______________________________________________________________________________________ 103 ____________________________________________________________________________ Kosovo Health Master Plan Agim Morina – pharm tech Mamushe QMF Head Nurse – Zymryt Kala and nursing staff Dentist Mitrovice Municipality Shaqir Demiri - Director Health & Social Welfare Mitrovice QKMF Mitrovice Hospital Sanije Meholli -Director Director – Drita Fazliu Family Medicine director Administration Director - Chief dentist Head of Paediatrics Department Dental staff Gynecology Department staff Emergency Department staff Emergency Department staff Dialysis unit staff Novo Berde Municipality Director H&SW – Xhemail Novoberdaliu Municipality Director- Bajrush Ymeri Novo Berde MFMC Director – Rrahim Veliu & staff Obiliq (Kastriot) Municipality Fatmir Berbatovci – Director Dr Ymer Krasniqi – Chief of Health Sector Mihane Mjekiqi – Chief of Social Welfare sector Obliiq QKMF Mentor Preniqi Director Vjollca Hoti – chief FM dept Rejhane Zhushi Musliu – HR Mevlyde Restelica – head nurse Zyrafete Shaljani – HIS Fatmir Mena – emergency Ibrahim Berisha – radiologist Paediatrics staff including Shuqa Adeti; Violeta Husenaj Peje municipality Director Health & Soc Welfare – Xhafer Dema Peje MFMC Peje hospital Director - Islam Husaj CEO – Skender Dreshaj Kujtim Zajmi Medical Director & Head of Prof council Internal med –Edmond Haliti Enver Muja Gynecologist – Jashar Lajci Shemsedin Muhaxheri Accounting – Arbresha Admin services –Gani Mucolli Main Technician - Dem Curri Head of Nursing Dental Department staff Laboratory Department staff IT Department staff Emergency Department staff Radiology Department staff Report 2: Data ______________________________________________________________________________________ 104 ____________________________________________________________________________ Kosovo Health Master Plan Transfusion Department staff Paediatrics Department staff Besiane (Podujeve) Municipality Dr Bahri Thaqi Podujeve QKMF Maternity Unit Dr Ekrem Hyseni – Director Staff Xhabire Ibrahimi – dermat Rifat Salihu – dep director Burim Hasani – head technician Prishtine Municipality Director H&SW Rame Miftari (have card) Pristine MFMC Prishtine City Emergency Centre Dep Director – Drita Peqani Haki Dragusha Avdullah Hoti – Chief FM Agron Ruva Myrvete Sopi – Head Nurse Staff Lab- Besa Canhasi XRay radiologist Ex-Public pharmacy XRay tech – Skender Begolli Pharmacist Prishtine University Clinical Centre Director QKUK - Jusuf Ulaj Deputy Director - Afrim Blyta Education Manager Director ORL and staff Ophthalmology staff Director Gynecology and staff Director Pediatrics and staff Director Internal Medicine and staff Surgery staff Director Endocrinology and staff Director Neonatal ICU and staff Director Infectious disease & staff Emergency Department staff Pathology Institute staff Director Neurology & staff Director Psychiatry & staff Dep Director Dermatovenerology & staff Abdominal surgery clinic staff Coronary Care unit staff Dialysis unit staff Gastroenterology staff Director Plastic surgery & staff Director Pulmology University Clinical Centre of Dentistry Director & staff Report 2: Data ______________________________________________________________________________________ 105 ____________________________________________________________________________ Kosovo Health Master Plan Prizren Municipality Blerime Oseku - Health Coordinator Assistant/ accountant Prizren QKMF Prizen Regional Hospital – Prim Dr Daut Mustafa Director - Narqize Hoxhaj Director - Myzafer Kalanderi Laboratory staff Head Pharmacy Radiology staff Head Emergency - Sadri Hulaj Emergency centre staff Emergency Department staff Dental Department staff Pharmacy staff Medical records staff Laboratory staff Radiology Department staff Rahovec Municipality Dir H&SW - Ejup Zeka Rahovec MFMC Maternity Unit Director- Ibrahim Vuciterna Gynecologist – Shazije Vuciterna Quality coordinator – Qazim Cana Midwives including – Makfire Shtavica Head nurse – Bukurije Canta Laboratory technician – Arjeta Kaja XRay technician – Vahid Kadiri Shtime Municipality Director H&SW – Fatmir Emini Chief of Health – Reshat Gashi MFMC TB unit Agim Zejna Mehmet Alibegu Muse Baftiu – head tech XRay dept staff: Osman Ismajli Integrated Mental Health Centre Laboratory staff: Sevdije Imeri; Shaban Hetemi Nursing staff Emergency dept staff: Emirjeta Bajrami; Ali Derguti; Luljeta Selimaj Skenderaj Municipality Dr H&SW – Nazif Gogjuli (occupant med) Skenderaj QKMF Maternity dept Fazli Kadriu – gynaecologist Midwives – Faza Gashi; Ajshe Mjekiqi Emine Shabani Ferat Kabashi – head technician Hetem Musliu – paediatrician Emergency room staff including Aferdita Rama Laboratory technician – Ramiz Rama Strpce Municipality Director Health & SW – Tefik Islami Slavisa Vasiljevic – Chief Health Sector Brod punkt & Drajkovc FMC Director - Imer Murati Report 2: Data ______________________________________________________________________________________ 106 ____________________________________________________________________________ Kosovo Health Master Plan Suhareke (Thendarhe) Municipality Ardian Shala – Director H&SW Salih Butyqi – Chief H&SW Shehide Bytyqi – Budget & Finance Suhareke QKMF Maternity Unit Hidajete Haliti – Family Medicine Specialist Adem Halitaj – Gynecologist Bukurije Berisha – pharmacy technician Selim & Hidajete Berisha Fatmire Bicaj – Family Medicine Specialist Rrahim Elshani – radiology technician Hylnaze Aliu; Xhevahire Gallapeni – vaccination unit Sanije Bajraktari; Ganimete Kuci; Durak Obrazhda; Samir Ademi – laboratory technicians Viti Municipality Maternity Unit Dir H&SW – Taip Alidema Staff Viti MFMC Director – Nazim Dauti and staff Vushtrri Municipality Director Health & Social Services - Iliriana Nura Budgeting officer Vushtrri QKMF Vushtrri Hospital Director - Safet Idrizi Director – Vedat Mulaku Chief budgeting officer Head of Nursing Medical staff Obstetrician Vaccine unit staff Midwives Pharmacy staff Internal Medicine Department staff Surgery Department staff Report 2: Data ______________________________________________________________________________________ 107 ____________________________________________________________________________ Kosovo Health Master Plan APPENDIX II. HEALTH CARE FACILITIES IN KOSOVO 1. Main Family Medicine Centres Facility Municipality Facility Municipality QKMF Adem Ukehaxaj Decan QKMF Novoberde Novoberde QKMF Dragash Dragash QKMF Obiliq Obiliq QKMF Ferizaj Ferizaj QKMF Peja + Emergency; QKMF Fushe Kosovo Fushe Kosovo Mother & Child Centre Peja QKMF Gjakova Gjakova QKMF Podujeve Podujeve QKMF Gjilan Gjilan QKMF Prishtina + Stomatologia Prishtina QKMF Drenas Gllogovc (Drenas) QKMF Prizren Prizren QKMF Istog Istog QKMF Rahovec Rahovec QKMF Kacanik Kacanik QKMF Skenderaj Skenderaj QKMF Kamenice Kamenice QKMF Shterpce Shterpce QKMF Kline Kline QKMF Shtime Shtime QKMF Lipjan Lipjan QKMF Suhareka Suhareka QKMF Malisheve Malisheve QKMF Viti Viti QKMF Mamushe Mamushe QKMF Vushtrri Vushtrri QKMF Mitrovica Mitrovica Sth DZ Zubin Potoc Zubin Potoc DZ Mitrovice Nth Mitrovice Nth Zavod Zdravlja Za Zastitu Zvecane 2. Family Medicine Centres Facility Municipality Facility Municipality QMF Isniq Decan QMF #1 Gjakova QMF Strellc Decan QMF #2 Gjakova QMF Irzniq Decan QMF #3 Gjakova QMF Krushev Dragash QMF Brogova Gjakova QMF Llopshnik Dragash QMF Cermjan Gjakova QMF Rapqa Dragash QMF Dardani Gjakova QMF #1 Ferizaj QMF Ereniku Gjakova QMF #2 Ferizaj QMF Orize Gjakova QMF Greme Ferizaj QMF Ponoshec Gjakova DZ Kosovo Polje Fushe Kosovo QMF Skivjan Gjakova QMF Maradi e Ulet Fushe Kosovo QMF 28.11 #2 Gjilan QMF Miradi e madhe Fushe Kosovo QMF Arberi #5 Gjilan QMF rabovc Bardhi I ulet Fushe Kosovo QMF Bresalc Gjilan QMF Sllatine e madhe Fushe Kosovo QMF Cernice Gjilan QMF Ujmir Fushe Kosovo QMF Dheu I bardhe #4 Gjilan DZ Ugljare Fushe Kosovo QMF Kuvc e Ep Gjilan QMF Vragoli Fushe Kosovo QMF Malisheve Gjilan Report 2: Data ______________________________________________________________________________________ 108 ____________________________________________________________________________ Kosovo Health Master Plan Facility Municipality Facility Municipality QMF Miresh Gjilan QMF Mllosheve Obiliq QMF Perlepnice Gjilan QMF Plemetin Obiliq QMF Pograghe Gjilan QMF #1 Peja QMF Ramiz cernica #6 Gjilan QMF Vitoramic Peja Gjilan (or QMF #3 Peja QMF Ranilug Kamenice?) QMF #4 Peja QMF Zhegra Gjilan QMF #2 Peja DZ Centar Gjilan QMF #5 Peja QMFDardani #3 Gjilan QMF Zahaq Peja QMF Kuvc e Ep Gjilan QMF Radavc Peja QMFPasjane Gjilan QMF Lluzhan Podujeve QMF Baice (Rezistence) Gllogovc (Drenas) QMF Kerpimeh Podujeve QMF Gilaneselle (Shkabe) Gllogovc (Drenas) QMF Podujeva 2 Podujeve QMF Komoran (Bushat) Gllogovc (Drenas) QMF Gllamnik Podujeve QMF Orliat (Arllat) Gllogovc (Drenas) QMF Bradash Podujeve QMF Terstenik (Qendrese) Gllogovc (Drenas) QMFBajqin Podujeve QMF Hani I Elezit FHC Hani I Elezit QMF Orllan Podujeve QMF Gurakoc Istog QMF Majac Podujeve QMF Rakosh Istog QMF Pollat Podujeve QMF Vrell Istog QMFBatllav Podujeve QMF Junik Junik QMFHalabak Podujeve QMF Gracanica Gracanica QMF Sfecel Podujeve QMF Kacanik te vjeter Kacanik QMF Shajkovc Podujeve QMF Hogosht Kamenice QMF Llapashtic Podujeve DZ Kamenice Kamenica QMF Besi Prishtina QMF Rogoqice Kamenice QMF #1 Prishtina QMF Sjerk Kline QMF #2 Prishtina QMF Ujmir Kline QMF #3 Prishtina QMF Zllakuqan Kline QMF #4 Prishtina DZ Leposavic Leposavic QMF #5 Prishtina DZ Donja Gusterica Lipjan QMF #6 Prishtina QMF Gadime Lipjan QMF Hajvali Prishtina QMF Janjeve Lipjan QMF keqekoll Prishtina QMF Magure Lipjan QMF Kishnice Prishtina QMF Shale Lipjan QMF llukar Prishtina QMF Kiev Malisheve QMF Matiqan Prishtina QMF Shipol Mitrovica QMF Mramor Prishtina QMF Ilirida Mitrovica QMF Rimanisht Prishtina QMF Tuneli I pare Mitrovica QMF Shkabaj Prishtina QMF Shupkofc Mitrovica QMF Sliviv Prishtina QMF Sheshi I vjeter Mitrovica QMF #1 Prizren QMF Jasenoivik Novoberde QMF Gjonaj Prizren QMF Prekovc Novoberde QMF Hoqe e qytetit Prizren QMF Tuller Novoberde Report 2: Data ______________________________________________________________________________________ 109 ____________________________________________________________________________ Kosovo Health Master Plan QMF Korishe Prizren Facility Municipality Facility Municipality QMF Muzeqine Shtime QMF Lakuriq Prizren QMF Gjinoc Suhareka QMF Pirane Prizren QMF Mushtischt Suhareka QMF Ralin Prizren QMF Studencan Suhareka QMF Reqan Prizren DZ Kllokot Kllokot /Viti QMF Romaje Prizren QMF Pozheran Viti QMF Zhur Prizren QMF Sadovin Viti QMF Fortes Rahovec QMF Sllatin Viti QMF Krusha e Madhe Rahovec QMF Smir Viti QMF Qifllak Rahovec QMF Verbovc Viti QMF Ratkoc Rahovec QMF Novolan Vushtrri QMF Likoc Skenderaj DZ Priluzje Vushtrri QMF Prekaz I eperm Skenderaj QMF Pantine Vushtrri QMF Qirez Skenderaj QMF Lumi Bardh Vushtrri QMF Runik Skenderaj QMF Maxhunaj Vushtrri QMF Turiqec Skenderaj QMF Smrekonice Vushtrri QMF Drajkovc Shterpce 3. Punkt/Ambulancas Facility Municipality Facility Municipality Pobergj Decan Mirash Ferizaj Lumbardh Decan Neodime Ferizaj Gramaqel Decan Softaj Ferizaj Prapaqan Decan Talinivci Ferizaj Prelep Decan Bardh I madh Fushe Kosovo Ratsih Decan Fushe Kovovo Fushe Kovovo Kosav Dragash Kozmin Fushe Kosovo Bellobrad Dragash Punkti ashkali Fushe Kosovo Bresan Dragash Bec Gjakova Blaq Dragash Brekoc Gjakova Brod Dragash Danjan Gjakova Kuke Dragash Doblibare Gjakova Radesh Dragash Dol Gjakova Restelic Dragash Gergoc Gjakova Vraniq Dragash Guska Gjakova Bablak Ferizaj Korenice Gjakova Babushi Ferizaj Kralan Gjakova Dardani Ferizaj Lipovec Gjakova Gacke Ferizaj Moliq Gjakova Greme Ferizaj Novoselle Gjakova Jezerce Ferizaj Sheremet Gjakova Komogllave Ferizaj Shqiponja Gjakova Report 2: Data ______________________________________________________________________________________ 110 ____________________________________________________________________________ Kosovo Health Master Plan Facility Municipality Bosce Kamenice Vishtazhin Gjakova Facility Municipality Budriga Gjilan Bozhevc Kamenice Kishna pole Gjilan Bushince Kamenice Kisha e Qytetit Gjilan Busavate Kamenice Koretistu Gjilan Desivojce Kamenice Kuscu Gjilan Domarovc Kamenice Livoq I eperm Gjilan Karaqeve Kamenice Livoq I poshtem Gjilan Kolloleq Kamenice Llashtice Gjilan Kopernice Kamenice Makresh Gjilan Koretine Kamenice Parallove Gjilan Korminjan Kamenice Shilovo Gjilan Krileve Kamenice Shurdhan Gjilan Lisocke Kamenice Straze Gjilan Muqiverce Kamenice Uglar Gjilan Rajanov Kamenice Verbic e zhegovcit Gjilan Ropotove Kamenice Abri e Eperme Gllogovc (Drenas) Shipashnice e Eperme Kamenice Dobroshefc (Dritan) Gllogovc (Drenas) Strezovc Kamenice Gradice (Dodone) Gllogovc (Drenas) Topanice Kamenice Terdec (Grykas) Tugjec Kamenice Nekofc (Nikaj) Gllogovc (Drenas) Budisallc Kline Stankofc (Flamuras) Gllogovc (Drenas) Cerovik Kline Vasileve (Paklek/Malesi) Gllogovc (Drenas) Drenoc Kline Gorance Hani I Elezit Gllareve Kline Banje Istog Grabanic Kline Cerkole Istog Jagod Kline Dobrush Istog Jashanic Kline Dubrav Istog Jashanic Kline Kaliqan Istog Shtupel Kline Osojan Istog Babushe Lipjan Saradra Istog Banulle Lipjan Studenic Istog Dobraje Lipjan Veriq Istog Dobratin Lipjan Zaliq Istog Gushterice Lipjan Doganaj Kacanik Kraishe Lipjan Begrace Kacanik Lepi Lipjan Bicaj Kacanik Livagje Lipjan Gure Zi Kacanik Rubovc Lipjan Lisnaje Kacanik Sllovije Lipjan Lum Bardhe Kacanik Bellanic Malisheve Qafe Shqipe Kacanik Ceralluk Malisheve Stagove Kacanik Dragobil Malisheve Ajnovc Kamenice Drenoc Malisheve Fshati I ri Malisheve Report 2: Data ______________________________________________________________________________________ 111 ____________________________________________________________________________ Kosovo Health Master Plan Facility Municipality Drelaj Peja Kavaqari Malisheve Facility Municipality Lozic Malisheve Gorazhd Peja Lumizad Malisheve Haxaj Peja Pagurush Malisheve Dumnic Podujeve Panoc Malisheve Dobratin Podujeve Terpez Malisheve Dyz Podujeve Bare Mitrovica Murgull Podujeve Bair Mitrovica Lupc i poshtem Podujeve QMF Koshtove Mitrovica Livadic (Livadhishte Podujeve Kciq Mitrovica Hertice Podujeve Guchafc Mitrovica Bardhosh Prishtina Fidanishte Mitrovica Barilev Prishtina Caber Mitrovica Bullaj Prishtina Kodra e Minatoreve Mitrovica Flotacion Prishtina Rashan Mitrovica Koliq Prishtina Zhazhe Mitrovica Shashkovc Prishtina Broboniq Mitrovica Viti Prishtina Vilahi Mitrovica Arbane Prizren Bajgore Mitrovica Dardani Prizren Kaqanoll Mitrovica Granqoar Prizren Selac Mitrovica Jabllanice Prizren Zabergje Mitrovica Kushmine I Hasit Prizren Bistrice Mitrovica Libeqeve Prizren Llabjan Novoberde Lubinje e poshtme Prizren Breznice Obiliq Lubishte e Prizrenit Prizren Palaj Obiliq Lubna e eperme Prizren Shipitull Obiliq Lugishte Has Prizren Siboc Obiliq Manastirice Prizren Raushiq Peja Mushnikove Prizren Loxhe Peja Nashec Prizren Baran Peja Planej Prizren Leshan Peja Skorobishte Prizren Poqeste Peja Strugje Prizren Trestenik Peja Veleshe Prizren Ozrim Peja Vllashnje Prizren Trebovi Peja Zym Has Prizren Doberdo Peja Drenoc Rahovec Cryshec Peja Hoxha e madhe Rahovec Kryshec Peja Lagja veriore Rahovec Rahovec Gllogjan Peja Velika Hoca Rahovec Gorazdevac Peje Brezovica Shterpce Novosell Peja Cevce Shterpce Tenic Peja Gornja Ditnja Shterpce Viga Shterpce Report 2: Data ______________________________________________________________________________________ 112 ____________________________________________________________________________ Kosovo Health Master Plan Facility Municipality Facility Municipality Petrove Shtime Begunc Viti Pjetershtice Shtime Debelldeh Viti Aqareve Skenderaj Gjylekar Viti Izbice Skenderaj Letnic Viti Kline e eperme Skenderaj Remnik Viti Kllodernice Skenderaj Stubell Viti Llaushe Skenderaj Terpez Viti Polac Skenderaj Verbovac Viti Qubrel Skenderaj Zhiti Viti Rezall Skenderaj Dumnice Vushtrri Bukosh Suhareka Druar Vushtrri Duhel Suhareka Dubofc Vushtrri Drejkoc Suhareka Samadrexhe Vushtrri Mohlan Suhareka Ashlan Vushtrri Nishor Suhareka Strofc Vushtrri Samdregje Suhareka Ceceli Vushtrri Sopi Suhareka 4. Secondary and Tertiary Care Facilities Facility Municipality Ferizaj Regional Hospital Ferizaj Gjakova Regional Hospital Gjakova Gjilan Regional Hospital Gjilan Hirurska I Genkoloska Bolnica Gracinice Interna Bolnica Laplje Selo Bolnica Mitrovica Nth Mitrovice Regional Hospital Mitrovice Sth Peja Regional Hospital Peja Prishtine University Clinical Center Prishtine Prizren Regional Hospital Prizren Vushtrri Regional Hospital Vushtrri Report 2: Data ______________________________________________________________________________________ 113 ____________________________________________________________________________ Kosovo Health Master Plan 5. Facilities in parallel Serbian Primary Health Care System Facility Municipality Ropotove Kamenice Babush Ferizaj DZ Leposavic Leposavic Bablak Ferizaj DZ Donja Gusterica Lipjan Talinovc Ferizaj Dobratin Lipjan DZ Kosovo Polje Fushe Kosovo Gushterice Lipjan DZ Ugljare Fushe Kosovo Lepi Lipjan Fushe Kovovo Fushe Kovovo Livagje Lipjan DZ Centar Gjilan Rubovc Lipjan QMF Kuvc e Ep Gjilan DZ Kllokot Kllokot /Viti QMFPasjane Gjilan DZ Mitrovice Nth Mitrovice Nth QMF Ranilug Gjilan (or Kamenice?) Prekovc Novoberde Budriga Gjilan QMF Plemetin Obiliq Kisha e Qytetit Gjilan Babin Most Obiliq Koretistu Gjilan Gorazdevac Peje Kuscu Gjilan Livadhiste Podujeve Makresh Gjilan AMF Velika Hoca Rahovec Parallove Gjilan QMF Drajkovc Shterpce Ponesh Gjilan QKMF Shterpce Shterpce DZ Partesh Partesh/Gjilan Brezovica Shterpce Shilovo Gjilan Cevce Shterpce Straze Gjilan Gornja Ditnja Shterpce QMF Gracanica Gracanica Viga Shterpce Osojane Istog Verbovac Viti QMF Kamenice Kamenice DZ Priluzje Vushtrri AMF Ajnovc Kamenice Banjska Vushtrri AMF Bosce Kamenice Grace Vushtrri AMF Bozhevc Kamenice Gojbulje Vushtrri AMF Bushince Kamenice Zavod Zdravlja Za Zastitu Zvecane AMF Domarovc Kamenice DZ Zubin Potoc Zubin Potoc AMF Kolloleq Kamenice Komenjanu AMF Korminjan Kamenice Brekovcu Gjakova? AMF Rajanov Kamenice 6. Parallel Serbian Secondary Care Facilities Facility Municipality Hirurska i Genkoloska Bolnica Gracinice Interna Bolnica Laplje Selo Bolnica Mitrovica Report 2: Data ______________________________________________________________________________________ 114