Contributions_Spring_2024

 

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Two Kosovo Hospitals Awarded Membership to International Network

The Health Promoting Hospitals (HPH) approach, set to reshape Kosovo's healthcare landscape, prioritizes patient wellbeing through education, prevention, integrated healthcare, evidence-based practices, and community engagement. It brings sustainable change in healthcare delivery by empowering patients to self-manage their health.

In March, two general hospitals in Kosovo, Peja and Gjakova, received the membership certificates from the International Network of Health Promoting Hospitals and Health Services. Apart from beginning collaboration with health institutions worldwide and raising the level of service provision, the certificates demonstrate that certain processes and standards were followed and met.    

The rigorous process of self-assessment and establishing of standards that led the general hospitals of Peja and Gjakova to be awarded HPH network membership started in July 2023 with the establishment of a Working Group co-chaired by the Kosovo Ministry of Health and National Institute of Public Health. The working group developed a hospital program based on the 2020 Hospital Health Promotion Standards, in full alignment with Kosovo’s National Action Plan for Health Education and Health Promotion and the country’s specific needs.

Central to this work were the baseline assessments at each hospital to identify key areas and priorities to serve as basis for the strategies to integrate health education into the practice and workflow of care, develop training programs for hospital staff, and establish monitoring and evaluating mechanisms.

As non-communicable diseases require patient contribution and engagement – that is no less important than the medical protocols for their treatment – this approach increases the efficiency of every medical protocol that is implemented. Hence, the HPH approach is paving the way towards a new mindset in healthcare delivery.

Speaking at the certificate award ceremony, Dr. Naim Bardiqi, Secretary General of the Ministry of Health of Kosovo, considered membership to the HPH international network a significant milestone.

“This achievement is proof of the efforts and dedication of the hospital's management and staff with a focus on patients, thus bringing the hospital to new levels in the provision of health services,” Dr. Bardiqi stated.

Dr. Bardiqi emphasized the transformative impact the HPH journey and its several dimensions, such as quality improvement projects identified for both hospitals, further strengthening of the capacities of health workers, their active involvement in the design and implementation of action plans and health education, and other initiatives for digitalization of patient records, regulation of patient flow, and patient surveys.

“The Ministry of Health pledges to continuously support new and innovative initiatives that pave the way for the development and implementation of self-care programs for patients with hypertension and diabetes. By empowering the patient to take control of their own health and well-being, we are not only improving their quality of life, but reducing the burden on our healthcare system,” stated Dr. Bardiqi at the ceremony.

Ultimately, the membership of the General Hospitals of Peja and Gjakova in the International Network of Health Promoting Hospitals marks a significant stride towards inspiring a healthier future for all in Kosovo.

Facilitated through the Integrated Health Services project in collaboration with OptiMedis AG and their experts, the HPH approach feeds into the Ministry’s strategic objectives with a special focus on non-communicable diseases, particularly diabetes and hypertension.

The IHS project is a joint, 4-year initiative between the Kosovo Ministry of Health and the Swiss Agency for Development and Cooperation, facilitated by the Swiss Tropical and Public Health Institute.

Watch the video


Contact: 
Linda Baleta
Swiss Public and Tropical Health Institute, Kosovo
LinkedIn | linda.baleta@ihsproject.org

Photo: 
Dr. Fazli Shala, Director, General Hospital of Peja in Kosovo, receiving the Health Promoting Hospital certificate © Linda Baleta, IHS Project

PEN training for PHC teams in the Republic of Moldova is completed!

The WHO package of essential non-communicable disease interventions for primary health care (PEN nr.1 and PEN nr.2) was approved and encouraged for implementation by the Ministry of Health after a feasibility study in February 2019. Training of primary care teams to integrate standardized protocol in practice was taken up by the Swiss TPH through the Healthy Life project.  Moldova comprises 35 administrative districts and two municipalities. Around 4,000 family doctors and PHC nurses are employed in the primary health care sector and required training.  The process was conducted in a snowball approach with every administrative district appointing 4-6 persons to become local PEN trainers.
In an accompanying activity, PHC facilities received the needed medical equipment for PEN implementation (ECG machines, lamps, pulse oximeter and other) and informational materials for health workers, patients, and their families. To keep the interest, online satellite seminars were also arranged e.g. on diabetic foot prevention. For future sustainability, the training has been taken up in the nursing curricula revision led by the Raisa Pacalo Center for Medicine and Pharmacy.  
 
The results of the training have been published here

Contact: 
Natalia Zarbailov
Swiss TPH, SDC Healthy Life Project, Moldova
Linkedln | natalia.zarbailov@viatasan.md

Photo:
© Healthy Life Project

Albania's Healthcare Progress: Quality of Care Metrics 2015-2022

Health for All Albania: Strategic Interventions Towards Inclusive and Quality Healthcare
In 2015, the Health for All Project – an initiative of the Swiss Agency for Development and Cooperation implemented by the Swiss Tropical and Public Health Institute - joined the efforts of the Albanian government to reform a struggling primary healthcare system. The country faced significant challenges marked by low budgets, poor quality of care, and limited accessibility, especially for vulnerable groups. Adopting a comprehensive “health strengthening system”, the project strategically identified the key elements that would yield the most important and sustainable results for inclusive and quality healthcare, such as empowering governance, managing human resources, updating clinical guidelines and protocols, and improving infrastructure. Now, eight years later, here is how these key interventions played out in steering Albania towards resilient, inclusive, and sustainable healthcare.

Empowering Governance and Management
Addressing the need for robust policies, the Health for All Project (HAP) supported the elaboration, approval and implementation of the Strategy of Primary Health Care 2020-2025. This strategic document marked a transformative shift, introducing new models of services, updating PHC job profiles, elaborating protocols and guidelines for the treatment of NCDs, mental health disorders and treatment of the elderly, as well as investing in the improvement of PHC infrastructure.
“Albania never had a Strategic Document on PHC in the past. HAP’s support has been remarkable in the elaboration of this strategic document, not only for providing insights related to infrastructure but also for introducing new models of PHC services, changes in the provider’s mentality on service provision, in the management of PHC services and the education of citizens”, stated Prof. Mira Rakacolli, Deputy Minister of Health.
Once better policies were in place, it was time to tackle the limited resources and poor management of the primary health system. The Master’s Program in Health Management (MHM) developed with HAP’s support significantly strengthened the country’s health management capacities and served as a motivating career step for healthcare staff.

Improving Accessibility and Sustainability: Home Healthcare and Empowered Nurse Role
Committed to bringing healthcare to those who need it most, HAP introduced a new dimension of homecare to serve homebound chronic patients and the elderly. The initiative not only eased the burden on caregivers but also empowered nurses with specialized training on advanced nursing procedures, contributing to improved patient outcomes in all the project’s intervention regions.
“Having the nurses visit at home is such a blessing. I have only been able to move him once before for some blood tests. Now they come periodically there’s no need for us to move him for his health checks. I’m very thankful as it’s a great help for us”, says M. B., the caregiving wife of a homecare beneficiary.
Along with the advanced training, the nurses’ role was further empowered with the development of new job profiles, including Nurse for Health Education and Check Up, Family Nurse, Community Nurse etc. fine-tuning the provided services to the community’s needs. The establishment of a Master’s program in Family Nursing was HAP’s pivotal contribution to shaping the new profile of family nurses as accomplished professionals, capable of working independently from doctors in addressing the evolving needs of the healthcare system.
Ms Ilirjana Zekja, Dean of the Faculty of Medical Technical Sciences called the Master in Family Nursing “a crucial intervention for generating family nurses capable of providing advanced nursing care in PHC, including home care on a regular basis”.
 

Improving Service Quality: Infrastructure, Updated Protocols, Medical Kits
HAP’s investment in infrastructure rehabilitation in collaboration with the municipalities and local health authorities was key in increasing population coverage with essential services as well as improving the quality of care in the respective communities. So far, 31 health facilities have been rehabilitated and rebuilt providing improved service for more than 240.000 citizens and improved working conditions for 432 health providers.
“The patient feels comfortable and enjoys their visit, as evident from the high flow of visits after the rehabilitation. There’s endless gratitude towards HAP, not only from the healthcare staff but above all from the patients”, says Dr Bajram Lami, a family doctor in a rebuilt health post.
 
HAP also actively contributed to the prevention and treatment of Non-Communicable Diseases (NCDs), by supporting the elaboration and implementation of the clinical guidelines and protocols for five NCDs, mental health disorders, and specialized care for the elderly, ensuring standardized and effective care and improving patient health outcomes.
 “The training offered by HAP has helped strengthen my capacities and competencies as a family nurse. They raised my professional confidence and improved my ability to improve the management of cardiovascular disease and diabetes, our most frequent culprits, as well as advise patients accordingly”, said Ms Mbaresa Dimo, a family nurse.
Assisting the implementation of the updated protocols and guidelines was also HAP’s distribution of medical bags with essential physical examination tools, ensuring the healthcare staff of 120 health centres is adequately equipped and the quality of care improved. 

Establishing and Strengthening Continuing Medical Education: Peer Groups
Peer Groups  have been key in the standardisation of health service practices among healthcare professionals. This, in turn, is crucial for the scaleup of the healthcare reform elements such as NCD protocols and guidelines, new home care services and more. A total of 977 family doctors and 4129 family nurses in the eight intervention regions have joined Peer Groups so far, with numbers increasing substantially year after year.
The Order of Nurses President, Ms Blerina Duka described Peer Groups as an “effective tool with direct impact on the quality of care” and Dr. Malvina Manga, a Healthcare Centre Manager and Family Doctor explained how being part of a Peer Group “improved my qualities as a leader, the relationship with my colleagues and raised my professional confidence”.
 
Consolidation Phase: Geographical Expansion and Collaboration
At its current Consolidation Phase, the project is working on further empowering local units of healthcare, reaching more communities, integrating additional services within the health centre and enhancing the inclusion of vulnerable groups through various advocacy initiatives.
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The Health for All Project’s impact has been manifold and invaluable making it a cornerstone for positive change in Albania's healthcare landscape. As WHO’s National Public Health Officer, Mr. Gazmend Bejtja observed “HAP has done such extraordinary work that it would be no overstatement to describe it as the “oxygen” of the Albanian PHC”.
i A Peer Group consists of a group of healthcare professionals, usually family doctors and nurses of the same health centre but not limited to, who meet up based on a pre-arranged plan to share experiences, knowledge, and expertise about their clinical practice. PGs are officially recognised as a CME activity and accredited accordingly.



Contact: 
Edlira Keta
Health for All Project, Albania

Photo:
©HAP
In February and March of 2024, two private companies supported by SDC’s Private Sector Partnerships in Health (PSPH) project introduced the first-ever affordable mass-market health insurance products to the people of Somalia and Somaliland, a pioneering development breakthrough in these fragile and predominantly uninsured markets. The significance of this cannot be underestimated, as although the private sector provides most healthcare services in Somalia and Somaliland, 98% of the population is uninsured and pay out-of-pocket when they access private care, placing an undue and unmitigated financial burden on families.

In a groundbreaking event, on 1st February 2024 in Mogadishu, Baraka Takaful Insurance launched the first-ever affordable health insurance product in Somalia, Kaaliye Care (“Care Assistant”). As mentioned, Somalia’s population is currently 98% uninsured; there is no social health insurance available, and the two percent with commercial policies typically pay premiums of $1,000 or more per month, meaning health insurance is only within reach of NGOs, UN agencies, and donor implementing contractors, the only ones who can afford them. Kaaliye Care coverage starts at only $15 per month, readily accessible to Somalia’s economically active but mostly informal mass market which comprises up to 80% of the population. Kaaliye Care is a true development breakthrough, lowering risk of financial exposure and reducing out-of-pocket expenditure for policyholders – a pioneering step towards Universal Health Coverage (UHC) in a vastly underserved market.

Just one month later, on 3rd March 2024 in Hargeisa, Wadaag Insurance launched its Daryeele (“Caregiver”) and Taakulo (“Assistance”) low-cost health insurance products, Somaliland’s first-ever affordable health insurance policies. Somaliland’s demographic profile is similar to Somalia’s, and the market is also practically uninsured. Daryeele starts at only $20 per month and higher-coverage-limit Taakulo starts at $30 per month. Wadaag Group’s CEO commented, "As a company, we are committed to providing affordable and accessible health insurance options for our customers. We believe that everyone deserves access to quality healthcare, and we are proud to be able to offer this service to our community." Somaliland’s Minister of Religion and Endowment noted, “Insurance was created to tackle the challenges faced by humanity on a global scale. Finding solutions to these challenges brings us joy as we work towards resolving our own problems today.”

Two years of PSPH project assistance stands behind the market launch of Kaaliye Care, Daryeele, and Taakulo low-cost health insurance. PSPH’s mandate is to follow the Market Systems Development (MSD) approach, with the objective of increasing access to quality and affordable healthcare for all Somalis. The cornerstones of MSD are that it is facilitative, sustainable, scalable, systemic, and inclusive. PSPH, working with private sector partners, does not provide funds but rather acts as a healthcare consulting firm offering technical assistance – for example providing strategic action planning, market research, marketing strategy, product development, and network development. The PSPH approach is knowledge-based, not money-based. No cash changes hands with the partner – partners invest their own funds, taking full market risk and accepting full responsibility for both market successes and failures.

This launch is particularly noteworthy because Somalia has some of the world’s poorest health indicators. Overall, the healthcare system in Somalia remains weak, poorly resourced, and inequitably distributed. Health expenditure remains extremely low with an especially severe risk of financial burden on the poor. Somalia’s healthcare market is heavily distorted; for decades, healthcare has primarily been financed through direct funding from external donors, completed with out-of-pocket expenditures by the populace. Nearly half of total health expenditure in Somalia comes from donors, and most public health services available locally are provided free of charge by donors through implementing NGOs and UN agencies. This system based on external dependency is fragile and unsustainable.

Meanwhile, Somalia’s private healthcare sector is thriving, and although fragmented, underregulated, and concentrated in urban areas, delivers a 60% share of total health expenditure. PSPH seeks to harness the power of the private sector to strengthen the overall healthcare system and improve access to quality and affordable healthcare for all Somalis, especially disadvantaged groups.
The health insurance products in this case were introduced by two companies independent of each other because Somaliland and Somalia have different administrative structures and requirements.

PSPH is unique in the highly donor-distorted Somali health market, where the public sector has few resources of its own and donors have reported 85 projects valued at nearly $200 million in 2023, primarily offering direct delivery of services. Currently, PSPH is the one and only donor-funded health project in Somalia and Somaliland that works with the commercial private sector, but it is dwarfed in size by conventional direct-delivery donor projects. It is currently the only dedicated MSD project in the healthcare sector anywhere in the world. Its lessons need to be more widely disseminated, since the approach embeds permanent indigenous capacity while giving SDC high leverage for their investment. PSPH is a living example of a modestly funded cutting-edge project punching well above its weight to achieve a fully localized, unsubsidized, sustainable, scalable solution to a real public need.
PSPH is implemented by DT Global, supported in its efforts by The Somali Research and Development Institute (SORDI) and The Swiss Tropical and Public Health Institute (Swiss TPH). The multinational PSPH team manages the overall project out of DT Global’s Africa headquarters in Nairobi via field offices and full-time field teams in Mogadishu and Hargeisa.


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© 2024 DTGlobal