Snežana Simić

Inequalities that hurt: demographic, socio-economic and health status inequalities in the utilization of health services in Serbia

BACKGROUND The aim of this study was to analyse demographic, socio-economic and health status inequalities by gender in the utilization of health services in Serbia. METHODS Data from 2006 National Health Survey for Serbia were used. A total of 14,522 persons from six geographical regions of Serbia aged >or=20 years were completely interviewed. Logistic regression analyses were used to study the effects of demographic (age, gender, marital status and type of settlement), socio-economic (education and Wealth Index) and health status (self-perceived health) variables on the utilization of health services [visits to general practitioner (GP), private doctor, dentist and hospitalization]. All analyses were carried out separately for males and females. RESULTS As compared with women (reference category), a lower percentage of men visited a GP [odds ratio (OR) = 0.61; 95% confidence interval (95% CI) = 0.57-0.65], private doctor (OR = 0.62; 95% CI = 0.57-0.67) and dentist (OR = 0.81; 95% CI = 0.76-0.87), but there were no gender differences in hospitalization. Both males and females who belong to disadvantaged classes were less likely to have visited a GP, a private doctor or a dentist in 12 months before the interview, regardless of their health status. No inequalities by social class were observed for the hospitalization among persons with poor self-perceived health status, i.e. those in most need. CONCLUSIONS This study has shown that demographic, socio-economic and health status inequalities in the utilization of health services exist in Serbia. Wise health policy with equitable utilization of health services, regardless these inequalities should be a priority in shaping Serbian health care system reform.

Help-seeking behaviour of Serbian women who experienced intimate partner violence

OBJECTIVE This study aimed to identify whom women in Serbia approach for help in case of intimate partner violence (IPV), their reasons for seeking help and their satisfaction with the received help. METHODS A cross-sectional, population-based household survey of a random sample of women aged 15-49 years was conducted in Belgrade (WHO Multi-country Study on Womens Health and Domestic Violence against Women). A standard questionnaire was administered by trained interviewers through face-to-face interviews. RESULTS The questionnaire was completed by 1456 women and 1196 of them ever had an intimate partner. Almost one in four ever-partnered women reported experiencing either physical and/or sexual violence, at least once in their life. Among these abused women, ≈ 22% had ever sought help from formal institutions. Police and health services were most commonly approached (12% and 10% of abused women, respectively). Satisfaction with services was highest for health services and legal advice and lowest for police and social services. Women sought help especially when violence had a severe impact on them or when they saw that their children suffered. Women who did not seek help stated that they believed that the violence was bearable or had ended. Other reasons for not seeking help were fear of undesirable consequences of seeking help and lack of trust in institutions. CONCLUSIONS From the abused womens perspective, health care services are the institutions with the highest potential to help women in cases of IPV. Developing a comprehensive health sector response is of critical importance to ensure appropriate care and referral.

Framework for the strategic and business planning of the Centre – School of Public Health, Belgrade

The science and practice of the New Public Health have a key role in the promotion of people’s health and in the reform of the health system. Serbia experienced many social and economic threats to public health during the 1990s when the health infrastructure both for curative and preventive services gradually deteriorated. Existing skills and knowledge of public health professionals are insufficient in virtually all fields of public health activities. The foundation of the Centre – School of Public Health, within the Medical School of Belgrade University has been a precondition for the improvement of professional training in public health. The objectives are described as (1) education of capable experts in the field of public health, (2) improvement of knowledge in the health sciences, (3) health promotion in cooperation with local communities, (4) training of competent researchers in the field of public health and (5) improvement of the process of decision making and policy formulation. The training programme covers five key areas of education in the domain of public health: (1) public health in Europe, (2) epidemiology and biostatistics, (3) health policy and management, (4) health promotion, health education and social sciences and (5) environment and health. In the first year, 27 students were admitted for the Master of Public Health programme and more than 350 participants attended various short courses for continuing education in public health and health management based on applied learning approach. The next developmental steps focus on sustainability of the programmes for continuing education and research and a wider national and international partnership.

Master’s programmes in public health sciences in Serbia: Future perspectives

AimThis manuscript deals with public health training, research and practice in order to identify the future perspectives and requirements of master’s programmes in public health sciences in Serbia.MethodsA wide array of documents and websites was analysed. The methods used for data collection were: (1) review of the existing written reports, the relevant legislation and other documents, and (2) Internet searches accessing the websites of the Ministries of Health, Education, Science and Technology of the Republic of Serbia as well as websites covering thematic areas in European and global education, research and development. Use has also been made of the results of the European Union projects done in the field of public health in Serbia, particularly the Tempus programme “Postgraduate Studies in Public Health Sciences”.ResultsThe most important role in the field of change in public health in Serbia is played by the School of Public Health (SPH) and the Institutes of Public Health (IPH). Although at the managerial level the need for change has been perceived, in general there is not a shared, clear vision of what the change should be and how this should happen. The reorganisation of the IPH in Serbia is greatly needed given their poor present performance and the expectations of the government to reach EU standards and to increase the health status of the Serbian population. The main obstacles are seen to be inappropriate legislation, lack of financial resources and insufficiently trained staff. Three areas with priority for future development have been identified: (1) doctoral programmes in public health and in health policy and management, (2) expansion of continuing and life-long learning in good governance and public health management, and (3) increasing the research base in public health and management.ConclusionThe need for a better trained workforce in the fields of public health, health management and health promotion is clearly recognised by public health professionals in Serbia. Therefore, the educational infrastructure should be amended by doctoral programmes and life-long learning schemes, based on intensified public health research.

Land Sensitivity Analysis of Degradation using MEDALUS model : Case Study of Deliblato Sands, Serbia

Abstract This paper studies the assessment of sensitivity to land degradation of Deliblato sands (the northern part of Serbia), as a special nature reserve. Sandy soils of Deliblato sands are highly sensitive to degradation (given their fragility), while the system of land use is regulated according to the law, consisting of three zones under protection. Based on the MEDALUS approach and the characteristics of the study area, four main factors were considered for evaluation: soil, climate, vegetation and management. Several indicators affecting the quality of each factor were identified. Each indicator was quantified according to its quality and given a weighting of between 1.0 and 2.0. ArcGIS 9 was utilized to analyze and prepare the layers of quality maps, using the geometric mean to integrate the individual indicator map. In turn, the geometric mean of all four quality indices was used to generate sensitivity of land degradation status map. Results showed that 56.26% of the area is classified as critical; 43.18% as fragile; 0.55% as potentially affected and 0.01% as not affected by degradation. The values of vegetation quality index, expressed as coverage, diversity of vegetation functions and management policy during the protection regime are clearly represented through correlation coefficient (0.87 and 0.47).

Demographic and socio-economic factors associated with multiple health risk behaviours among adolescents in Serbia: a cross sectional study

BackgroundThe aim of this study was to examine the relationships between demographic and socioeconomic characteristics and engaging in multiple risk behaviours among adolescents in Republic of Serbia.MethodsThis study presents a cross sectional study of 683 adolescents aged 15 to 19 attending high school. The database from the 2006 National Health Survey was used. As a measure of demographic and socio-economic characteristics: age, type of settlement, family structure, having one’s own room, school success and the household wealth index were used. Multivariate logistic regression model was performed.ResultsBoys were more than twice as likely to engage in multiple risk behaviours than girls. Adolescents who were older (OR = 5.82, 95% CI = 3.21–10.54, boys; OR = 3.76, 95% CI =1.77–7.99, girls) and adolescents who achieved low or moderate (OR = 1.82, 95% CI = 1.02–3.26, boys; OR = 3.36, 95% CI =1.51–7.44, girls) school success had significantly higher risk than younger ones and those with high school success. Also, boys who came from a richer class households (OR = 3.14, 95% CI =1.02–9.66) and girls from incomplete family (OR = 5.07, 95% CI = 2.06–12.50) had higher risk than boys from the poorest households and girls from complete family.ConclusionsFurther preventive interventions in Serbia should be gender and age specific, oriented towards older adolescents, those who have low or moderate school success, boys from richer class households and girls who live in incomplete families.

Development of a Master of Health Policy and Management programme in the framework of the Tempus project at the Centre School of Public Health, Belgrade

BackgroundThe most important instrument of EU support for the reforms of higher education in the European countries with the final goal of joining the European Higher Education (HE) Area by the year 2010 is TEMPUS (Trans-European Mobility Programme for University Studies). So far, Tempus is the only EU programme providing support for the reform of HE in the Western Balkans.AimThe purpose of this paper is to present the new curriculum of the Master of Health Policy and Management programme, which will provide students in Serbia with the up-to-date knowledge and necessary skills to analyse options, define strategies, formulate and implement health policies, and manage solutions for the effective delivery of health services.MethodsWith financial support from the European Union’s Tempus project, the “Postgraduate Study in Public Health Sciences” core project team from the Centre School of Public Health (C-SPH) School of Medicine (SoM) in Belgrade, supported by European project partners from Dresden, Rome and Krakow, developed a new curriculum—the Master of Health Policy and Management (MHPM) programme. Project activities (courses, workshops and visits to partner institutions) took place in Belgrade, Dresden, Rome and Krakow throughout 2006–2009.ResultsThe MHPM programme, based on modular principles and a European Credit Transfer System (ECTS) approach (60 ECTSs), was established at the C-SPH SoM and approved by the University of Belgrade. The MHPM programme consists of two tracks: one for health-care services management and the other for public health management. The first generation of MHPM students enrolled at the C-SPH SoM, Belgrade, in September 2008. They successfully passed all obligatory courses. It is envisaged that the first MHPM students will graduate in autumn/winter 2009.ConclusionWe believe that the project will continue to deliver benefits to the project beneficiaries after the Commission’s financial assistance has been terminated. The MHPM programme will facilitate health-care administration reform, contribute to strengthening civil society and accelerate the development of democracy and the rule of law through good governance in Serbia.