Rebuilding a health care system: war, reconstruction and health care reforms in Kosovo

Abstract

This article explores the complexity of a health care system reforms in a post-conflict situation. It describes how the health care system was revamped immediately after the war, and then reorganized with Primary Health Care (PHC) as the fulcrum for change. It highlights the coordination problems, typical of a post-war situation when un-coordinated humanitarian assistance pours in. From the vantage points of Ministry of Health officials, the article details how the change process has gone over the years, the directions it has taken and the lessons learnt. It notes that reforms are often so fast that they outstrip the absorption capacity of the potential change agents because of their inadequate preparation for the new roles and responsibilities. This in turn threatens to undermine and weaken the very system that the reforms seek to strengthen. Several options adopted for change in Kosovo's health care system are at varying levels of implementation today. Some commentators have questioned if the policy for the new health care system has failed. We contend that there have been major organizational successes. But there are also shortcomings. There is also a potential danger that the health care system could partly revert to the old system. While some of the successes and shortcomings may be specific to Kosovo, many lessons learnt from Kosovo apply to health care reforms elsewhere.

Resource allocation strategies in Southeastern European health policy

“…The dynamic socioeconomic changes after the civil war and secession in 1999 brought substantial foreign investment to Kosovo's health sector. One of the unfavorable consequences of Serb retrieval was the resulting shortage of experienced managerial staff [20]. European Union administrative assistance was essential in terms of developing a legislative and financial framework for medical care provision in Kosovo.…”

“…Additional obstacles to effective health care access and satisfactory equity is uneven income distribution and poor infrastructure in rural mountainous regions. Kosovo's officially planned mid-term health reform adopted principles of cost-effectiveness [20], but real application of a ''value for money'' way of thinking among policy makers still needs to take place. Sustainable health system financing will be a long-term challenge.…”

Globalization and Health in Kosovo

“…Over 90% of clinics and health institutions were damaged during the war, and many private clinics of Albanian health professionals were destroyed. A general collapse of the public-service infrastructure, particularly water and electricity, deeply affected the health sector (Buwa & Vuori, 2006). The Serbian Ministry of Health assumed control of the Kosovo health system, and directors and boards of health institutions were forced to report directly to Belgrade.…”

“…At the end of the conflict in 1999, more than 400 donors and aid agencies came to Kosovo, and one of the main tasks was to reconstruct the war-damaged healthcare system (Buwa & Vuori, 2006). At first, a post-war health reform program was acclaimed as a success; however, the implementation of the reform itself proved to be more problematic than its creation, and as a result, the reform did not accomplish its expected outcomes (Percival & Sondorp, 2010).…”

Socio-Demographic Correlates of Satisfaction Level of Primary Health Care Personnel in Gjilan, Kosovo

“…Primary care physicians play a very distinct role in keeping down the costs of health care services through the gate-keeping function of primary care [11]. Keeping health care costs under control is important for Kosovo, a country which is under reconstruction after emerging from a devastating war [12]. At a time of ongoing reforms, the weakness of primary health care (PHC) service in Kosovo leads to low levels of satisfaction among general practice staff.…”