Development of family medicine in Kosovo

Introduction

Eastern Europe's medical systems are changing in an attempt to match increasing health demands with limited resources.1 New methods of delivery and financing are being introduced, and the World Health Organization's regional office for Europe has been active in helping develop primary health care.2 We describe the evolution of primary care in Kosovo and the lessons for other post-communist countries.

Development of health services

Before 1989 inpatient services in Kosovo operated through six hospitals. Primary health care was delivered through large clinics (health houses) in 29 municipalities that oversaw a network of small clinics (ambulantas and punctas). The healthcare system relied heavily on specialists. Primary healthcare services were divided among subspecialties by age, sex, and disease type and provided by general practitioners and nurses. Patients presented to hospitals for both primary and secondary care. Private medical practice was not permitted.

Most Kosovar Albanians were dismissed from management and senior positions in all public services during 1990 to 1992. The Mother Theresa Society set up a parallel primary healthcare system with 96 clinics throughout Kosovo, staffed and used by Albanian Kosovars. Private medical practice began to develop. A parallel system of medical education was also set up in these clinics and in private houses.

At the end of the war in Kosovo in 1999, the WHO assessed the health needs of Kosovo. The key recommendation was to strengthen and reorganise primary care.3 This principle was emphasised in the Health Policy for Kosovo, 2001,4 which recommended that patients should register with family doctors, with 2000 patients to each doctor plus two nurses, and that family doctors should also be personal doctors for first contact, having preventive as well as curative duties …