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Multimodal Assessment of the Primary Healthcare System of Serbia: A Model for Evaluating Post-Conflict Health Systems

Published online by Cambridge University Press:  28 June 2012

Brett D. Nelson ,
Snezana Simic ,
Lauren Beste ,
Dejana Vukovic ,
Vesna Bjegovic  and
Michael J. VanRooyen
Brett D. Nelson*
Affiliation:
The Center for International Emergency, Disaster and Refugee Studies, Johns Hopkins University School of Medicine; Department of Emergency Medicine, Johns Hopkins Bloomberg School of Public Health; Department of International Health, Baltimore, Maryland 21205, USA
Snezana Simic
Affiliation:
Institute of Social Medicine, Statistics and Health Research, Belgrade University School of Medicine, 11000 Belgrade, Republic of Serbia
Lauren Beste
Affiliation:
The Center for International Emergency, Disaster and Refugee Studies, Johns Hopkins University School of Medicine; Department of Emergency Medicine, Johns Hopkins Bloomberg School of Public Health; Department of International Health, Baltimore, Maryland 21205, USA
Dejana Vukovic
Affiliation:
Institute of Social Medicine, Statistics and Health Research, Belgrade University School of Medicine, 11000 Belgrade, Republic of Serbia
Vesna Bjegovic
Affiliation:
Institute of Social Medicine, Statistics and Health Research, Belgrade University School of Medicine, 11000 Belgrade, Republic of Serbia
Michael J. VanRooyen
Affiliation:
The Center for International Emergency, Disaster and Refugee Studies, Johns Hopkins University School of Medicine; Department of Emergency Medicine, Johns Hopkins Bloomberg School of Public Health; Department of International Health, Baltimore, Maryland 21205, USA
*
The Center for International Emergency, Disaster and Refugee Studies, The Johns Hopkins Bloomberg School of Public Health, 1830 E. Monument Street #6–100, Baltimore, MD 21205 USA E-mail: bnelson@jhsph.edu
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Abstract

Introduction:

Conflicts, social unrest, and disasters can significantly affect the ability of a healthcare system to provide for the needs of its citizens. The collapse of the primary healthcare system in Serbia is a model of the effects that civil unrest can have on the health of a population. However, with improving social and political conditions, focus now can be turned towards the greatly needed development and reorganization of the primary healthcare system in Serbia.

Due to the complexity of health-system reform in the post-conflict/post-disaster setting, attempts to restructure health services are fraught with pitfalls that often are unanticipated because of inadequate preliminary assessments. A multimodal assessment involving quantitative and qualitative methodologies may provide a more robust mechanism to identify key programmatic priorities and critical barriers for appropriate and sustainable health-system interventions. The purpose of this study is to describe a multimodal assessment using primary healthcare in post-conflict Serbia as a model.

Methods:

Integrated quantitative and qualitative methodologies—system characterization and observation, focus group discussions, free-response questionnaires, and Q-methodology—were used to identify needs, problems, and potential barriers to primary healthcare development in Serbia. Participants included primary healthcare providers and administrators from 13 institutions throughout Belgrade.

Results:

Demographic data indicate a well-established infrastructure of primary health centers and stations. However, focus group discussions and free-response questionnaires reveal significant impediments to delivery of care: (1) Inadequate equipment, supplies, and medications; (2) Poor financial investment; (3) Discouraging worker salaries; (4) Few opportunities for professional development; and (5) Little emphasis on or respect for primary healthcare. Q-methodology of provider perceptions and opinions supports these concerns, shows remarkable consensus among participants, and provides further insights toward system development by grouping respondents into distinctive types.

Conclusions:

This study identified the critical needs and barriers to development of primary healthcare in Serbia. This combined methodology may serve as a model for future health system assessments in the post-conflict and post-disaster settings.

Keywords

assessment of healthcare needsBalkansfactor analysishealthcare systemsprimary healthcareQ-methodologyqualitative researchquantitative researchSerbia
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 18 , Issue 1 , March 2003 , pp. 6 - 13
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

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