Today, with the aid of the international community [European Union (EU), World Bank (WB), World Health Organisation (WHO), United Nations Children's Fund (UNICEF), nongovernmental organisations (NGOs), Global Fund (GF), Stability Pact, etc.] the ministries of health in transitional countries in the South Eastern Europe (SEE) region are in the process of expanding the capacities and skills of the health workforce in order to achieve successful health care reform and accomplish necessary steps for EU integration. The aim of this paper is to review international community support to reconstruction of the health care in SEE countries, with main focus on the EU and WB donors and projects. Review was done on the basis of existing donor reports, Internet search (search of official Web sites and electronic databases, check of references from selected documents, and use of a generic Internet search engine) and authors' experience from different health projects. The governments of SEE countries, in order to create an effective and efficient health system, overcame a period of transition and soon or later became ready for the process of EU integration, and began working on the following issues: rehabilitation, reconstruction and equipping of health facilities; developing a health strategy and policy documents; legislation and financing framework; building institutional, human resource and management capacity; health care sector reform; support to public health development and restructuring of the pharmaceutical sector. In many SEE countries, the capacity of the Ministry of Health and Health Insurance Fund was strengthened, and policy and strategy documents were drafted to guide reorganisation and reorientation of health care services. The public health system was strengthened. A family medicine model was introduced and developed in most countries. Development of enabling legislation mostly followed proposed changes in the health system. Although progress on several important fronts in achieving transition and progress in the rehabilitation health sector in SEE countries is significant, a lot remains to be done. Experience in some countries can be used to stimulate, motivate and encourage professionals throughout the civil service to grasp with both hands the opportunities for positive change.
Interdepartmental, inter-organizational and more general interagency working groups are a relatively new and growing phenomenon, particularly in the public domain. They appear as an answer to new challenges and demands imposed as regards the existing organizational structures. The need for interdepartmental and interagency joint endeavour emerged in specific cases related to the un-ordinary, occasionally, and usually complex tasks that they have to perform. In such cases, resource, knowledge or even authorization of a single entity are not enough. Hence, different organizations have to work together: exchange information, share resources, coordinate actions, and, in general, behave in a cooperative manner. However, different departments in a single large organization also have their internal relationship dynamics. In case of organizations with complex structures, more departments, interfering functions, formalized organizational behaviour, rigid communication procedures, administrative and decision making bottlenecks, there are many opportunities for improvement. This is particularly the case with public service organizations. On the other hand (other then public administration), in the field of business relationships and industrial markets, there is a reliable history of awareness of the "network perspective" and comprehension that actors do not operate in isolation (Hakansson and Snehota, 1995). Efforts to improve organizational design of commercial companies are permanent and long-term. Research studies on organizational design discussed issues about functional and project forms (Galbraith, 1971) and proposed matrix organizational design. Miles and Snow (1986) pointed out the "dynamic network" as a new organizational form invented to respond to declining productivity and competitive requirements. They further developed the "dynamic network" concept and discussed it in the wider context of networks typology (Snow and Miles, 1992). The next step in the Management 2016/80
Background Adverse childhood experiences (ACE) are a risk factor for mental health disorders and serious somatic illnesses. There is a need for preventing ACE and using mental health care by youth who experienced them. Aims of this study were to examine which ACE are related to mental health service use and to identify a scope of unrecognized needs for these services among students who had experienced abuse/neglect in childhood. Methods Descriptive cross-sectional study was performed on a sample of 2.381 first-year students from six universities in Serbia in 2014. The survey instrument was a questionnaire developed by WHO and CDC. Thirteen ACE (covering household dysfunctionalities, abuse, neglect, peer and collective violence) and using of mental health services at least once during lifetime were assessed. Data were analyzed by univariate and multivariate logistic regression. Results Compared to respondents without particular ACE, odds (±95% CI) of mental health service use were higher only in those with next adversities: parental divorce, OR = 2,26 (1,53-3,33); suicidal/mentally ill family member, OR = 2,21 (1,42-3,44); witnessing partner violence, OR = 1,51 (1,04-2,18); peer violence, OR = 2,14 (1,51-3,03); collective violence OR = 1,48 (1,05- 2,10). Among respondents who had experienced emotional neglect, 81% have never used professional help. For physical neglect, physical and psychological abuse this percentage was 83%. Conclusions The study highlights ACE associated with mental health service use and shows a significant presence of unrecognized needs for these services. There is need for: determining barriers in this area and formulation of effective health promotion strategies; more consistent application of legislation; conducting screening on child abuse/neglect in families with a higher risk for them. Key messages High share of youth with childhood adversities remains without help of mental health specialists.It opens the issue of barriers on the side of youth as well as on the side of health system and society Considering consequences of adverse childhood experiences, there is need for comprehensive public health interventions in order to increase mental health service use among young people with ACE.
The last two decades of the twentieth century were difficult ones for health promotion in Serbia. The political, economic and social upheaval resulting from the civil conflict in the former Republic of Yugoslavia put enormous pressure on the health system overall and undermined a previously strong and effective health education and promotion service. In recent years the government, supported by external donors, has refocused attention on the need for high quality public health, including preventive activities as a central goal of the health reform process. This process is reviewed through a case study of a high profile health promotion campaign recently completed within the country. The potential for Serbia to regain its position as an innovator in community-based health care as well as the obstacles to be overcome are analysed.
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