Aleksandar Džakula

Evaluation of Croatian model of polycentric health planning and decision making.

OBJECTIVE To determine the progress in the development and implementation of health policies on a county level resulting from the learning-by-doing training provided through the County Public Health Capacity Building Program started in 2001 in Croatia. METHODS Modular training using management tools, public health theory and practice, and SMDPs Healthy Plan-it tool, followed by the self-evaluation of the progress made by county teams in health needs assessment and health policy development, implementation, and assurance. Fifteen county teams consisting of politicians, executive officers, public health professionals, and community members. RESULTS Twelve of 15 county teams completed the program. The teams made progress in the evaluated areas, although to a different extent, which did not depend on the amount of time they had or the governance experience. The differences in improvement depended on the differences in the strength of political, executive, and professional components of the teams. Teams with a strong political and/or executive component, but weak public health professional and community components made major improvements in policy development and/or assurance function, but performed less well in the health needs assessment and constituency building. The reversed was also true. CONCLUSION Learning-by-doing training program improved public health practices on a county level in Croatia.

Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries.

Our study reviewed policies in 8 high-income countries (Australia, Canada, United States, Italy, Spain, United Kingdom, Croatia and Estonia) in Europe, Australasia and North America with regard to hospitals in rural or remote areas. We explored whether any specific policies on hospitals in rural or remote areas are in place, and, if not, how countries made sure that the population in remote or rural areas has access to acute inpatient services. We found that only one of the eight countries (Italy) had drawn up a national policy on hospitals in rural or remote areas. In the United States, although there is no singular comprehensive national plan or vision, federal levers have been used to promote access in rural or remote areas and provide context for state and local policy decisions. In Australia and Canada, intermittent policies have been developed at the sub-national level of states and provinces respectively. In those countries where access to hospital services in rural or remote areas is a concern, common challenges can be identified, including the financial sustainability of services, the importance of medical education and telemedicine and the provision of quick transport to more specialized services.

Health care issues in Croatian elections 2005-2009: series of public opinion surveys

Aim To compare the results of a series of public opinion surveys on experiences with the health care sector in Croatia conducted in the time of elections and to analyze whether political party affiliation had any influence on issues of priority ranking. Methods The surveys were conducted during 2005, 2007, and 2009. They were administered through a Computer Assisted Telephone Interviewing method to representative samples of Croatian population and were statistically weighted according to sex, age, level of education, and political party affiliation. The random sampling of the person within the household was done using the table of random numbers. Results Health and health care system was the most important issue (58%) during the 2007 parliamentary election and the second most important issue during the 2005 and 2009 elections (46% and 28%). In the 2007 election, health care was viewed as most important by women, respondents with lower education levels, and respondents with lower income. In 2005, the most important health care issues were corruption and lack of funding (45% and 43%, respectively), in 2007 poor organization and lack of funding (43% and 42%, respectively), and in 2009 lack of funding and corruption (51% and 45%, respectively). Conclusion Health and health care system were consistently among the top two issues in all elections from 2005 to 2009. The top three most important health care sector issues were corruption, poor organization, and lack of funding. This indicates that political parties should include solutions to these issues in their health care policymaking.

Has anyone seen it? Health care in Croatian elections.

Over the past decade, public opinion surveys have shown that Croats are deeply dissatisfied with their health care system and asses it to be one of the most important issues. However, health care hardly makes it into any political discourse in Croatia. This study analyzes the results of a public opinion survey conducted before the 2007 parliamentary elections to find out what the public sentiment on health care performance in Croatia is and to analyze the reasons why health care is not addressed by political actors. Evidence suggests that while health care is the most salient issue today, the public often understands it poorly. Thus, in a political environment of competing issues, and given the complexity of tacking health care in the policy arena, politicians strategically avoid discussing the issue.

Origins and effects of the 2014–2016 national strategy for palliative care in Croatia

Croatia is among the last countries in Europe to develop organized palliative care at the national level. Real changes in this area started after the parliamentary elections in 2011 and culminated in the 2013 adoption of the Strategic Plan for Palliative Care Development 2014-2016. The National Board for Palliative Care (NBPC), appointed by the Ministry of Health, was in charge of creating a scalable palliative care model and national guidelines. The Board drew on experiences from both neighbouring countries with similar societies and/or health care models (Bosnia and Herzegovina, Poland) and an international leader in palliative care (United Kingdom). It recognised that provision of palliative care in Croatia, thus far based on volunteering and isolated enthusiastic activities, needed to be improved through professionalization, regulation, and organized development. A variety of policy measures was used to implement these changes, including the introduction of professional guidelines and new payment models. The development of new palliative care structures and services significantly increased the number of patients who could access palliative care, from around 1-2% of patients needing such care in 2011 to 20-35% in 2014. It also ensured the provision of more appropriate services at each point of the palliative care pathway. The Strategy was extended for the 2017-2020 period.

Are Andrija Štampar’s principles gone – forever and ever?

Secondary use of routinely collected health care data has for long been promising to provide better and less costly care (1). Defined as the use of clinical routine data outside direct patient care, secondary use can have many and varied objectives, for example, improvement of patient safety, identification of “best practice” approaches, conducting clinical research, continuous quality measurements and reports, identification of room for quality improvement, optimization of clinical documentation and its supporting systems, public health tasks, business management, accreditation, identification of market potential and commercial use, fraud detection and prevention, surveillance of adherence to guidelines and standards, compliance control, teaching and training, and disease, case, and therapy management (2).

Decentralization in Croatia's Health System

Although decentralization is based on the simple idea that smaller organizations, properly structured and steered, are inherently more agile and accountable than larger organizations, in the health system this idea requires much more exploration (Saltman et al. 2007). Health systems are large and composed of several subsystems, including health care providers, health financing, and public administration. All of them have their own organizational patterns and values. Furthermore, inside each of them are further divisions, sometimes with almost opposite approaches: health promotion, disease prevention, clinical medicine, or palliative care. All of these subsystems and divisions could recognize decentralization as an opportunity or a threat.

Is salt intake hidden risk for rural population: case study Village of Sjeverovac, County Sisacko-moslavacka?

Nutritional habits between urban and rural population differ as much as life style and socioeconomic standards of these populations. In Croatia, rural populations are mostly live stock producers. Their nutrition frequently depends on their own production, which includes high quantity of cured meat products, eggs and dairy products. Data were obtained from longitudinal the Croatian Adult health Survey and pilot cross-sectional survey in three villages in Sisacko-moslavacka county. Our findings show that there is no great difference between urban and rural population regarding salt intake. The difference is in the type of food and food preparation, as well as life style. We propose combination of more culturally and socially sensitive questionnaires along with analytical methods that include biological matrix, such as 24-hour urine collection.

Rainwater Collecting as a Part of Implementation of the Sustainable Development Principles on Croatian Islands — Old Habits for New Era

The article investigates availability and quality of drinking water along with possibilities of rainwater harvesting, as an element of sustainable development on four Croatian islands. Investigated islands, represent two main regions: northern and southern Adriatic coast. This division corresponds with gravity to two main macro regional centers on the coast and it is common in demographic, economic and sociological research. Data on local water resources, conditions and type of water supply, quality of water, prices, consumption of water, number and condition of cisterns and demographic records are collected and analyzed. Also, meteorological data on annual rainfall in past 26 years are collected and analyzed. Drinking water quality corresponds with Croatian law regarding physical and chemical parameters, while most of microbiological parameters are unacceptable. The results point out modest possibility of developing public water supply on islands. Average annual rainfall indicates that harvesting of rainwater should be integrated as additional water source on investigated islands which would save great quantities of the drinking water that are used as technical water and for the other purposes such as agriculture or forest fires. Also that would lower the household expenses for the water and diminish water crisis during the tourist season months. Natural water resources on Croatian islands are scarce and it is our ethical obligation to preserve them in favor of existing eco systems and long term exploitation.