70597
Public Disclosure Authorized
Public Disclosure Authorized
Public Disclosure Authorized
____________________________________________________________________________ Kosovo Health Master Plan
REPORT
TO
Government of Kosovo – World Bank
Health Sector Master Planning Project
Public Disclosure Authorized
2. DATA REPORT
Prepared by
Leone Coper
Andrew Parkes
June 2008
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____________________________________________________________________________ Kosovo Health Master Plan
Acknowledgements
Developing a national Master Plan is a very intensive and intrusive process
and involves many interviews with the personnel concerned. The authors
wish to express their gratitude for the time, effort and support which has
been enthusiastically devoted to this task by the Deputy Health Minister
Dr Mybera Mustafa and MSH Permanent Secretary Ilir Rrecej and the
many MSH and Municipal staff interviewed at the Ministry of Health, the
Municipalities and individual facilities.
We also thank Dr Curr Gjocaj for his assistance in arranging visits and
establishing the Working Group for the Project; and Project local
consultants Dr Dafina Ademi and Dr Valton Saiti for their knowledgeable
input and enthusiasm.
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Table of Contents
ACRONYMS ..................................................................................................................................6
EXECUTIVE SUMMARY................................................................................................................7
Key findings ........................................................................................................................................ 7
1.
INTRODUCTION .......................................................................................................... 13
Background....................................................................................................................................... 13
Objectives of the Master Plan Project ................................................................................................ 13
2.
DATA GATHERING ACTIVITIES ................................................................................. 15
Range of information sought ............................................................................................................. 15
Data Gaps and Issues....................................................................................................................... 19
3.
THE CURRENT NETWORK ......................................................................................... 21
Secondary and Tertiary Care............................................................................................................. 21
Primary Care..................................................................................................................................... 21
4.
HEALTH CONCERNS .................................................................................................... 23
Reasons for Seeking Primary Health Care ........................................................................................ 23
Number of insulin dependent diabetics & haemodialysis patients....................................................... 26
Reasons for seeking Outpatient care at QKUK .................................................................................. 27
Reason for Admission - Secondary Care ........................................................................................... 28
Secondary + Tertiary Care - some QKUK departments...................................................................... 29
5.
FINDINGS – Infrastructure.......................................................................................... 34
Population and population movements .............................................................................................. 34
Capital investment............................................................................................................................. 36
Assessing suitability as a health facility ............................................................................................. 37
Heating, cooling, and generators ....................................................................................................... 37
Drains and water ............................................................................................................................... 38
Cleaning and maintenance of health facilities .................................................................................... 38
Structures for monitoring health quality.............................................................................................. 39
Private Sector issues ........................................................................................................................ 40
6.
FINDINGS –– Activities .................................................................................................. 41
Primary health care services ............................................................................................................. 41
Maternity beds .................................................................................................................................. 44
Regional Hospital statistics by department ........................................................................................ 45
Health Information System ................................................................................................................ 50
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7.
FINDINGS - Resources ................................................................................................ 51
Budgeting ......................................................................................................................................... 51
Procurement ..................................................................................................................................... 52
Hospital department structure............................................................................................................ 53
Hospital beds and staffing ................................................................................................................. 54
Hospital average bed occupancy....................................................................................................... 56
Primary Health Care Staff.................................................................................................................. 58
Numbers and types of unemployed health workers............................................................................ 61
Pharmaceuticals ............................................................................................................................... 63
Equipment......................................................................................................................................... 65
Emergency Vehicles ......................................................................................................................... 67
8.
THE CURRENT NETWORK BY MUNICIPALITY ......................................................... 70
8.1
Decan ................................................................................................................................... 70
8.2
Dragash .................................................................................................................................. 71
8.3
Ferizaj..................................................................................................................................... 72
8.4
Fushe Kosove ......................................................................................................................... 73
8.5
Gjakove .................................................................................................................................. 74
8.6
Gjilan ...................................................................................................................................... 75
8.7
Gllogoc (Drenas) .................................................................................................................... 76
8.8
Hani I Elezit............................................................................................................................. 77
8.9
Istog........................................................................................................................................ 78
8.10
Junik ...................................................................................................................................... 79
8.11
Kacanik .................................................................................................................................. 79
8.12
Kamenice .............................................................................................................................. 80
8.13
Kline ...................................................................................................................................... 81
8.14
Lipjan .................................................................................................................................... 82
8.15
Malisheve .............................................................................................................................. 82
8.16
Mamushe .............................................................................................................................. 83
8.17
Mitrovice South....................................................................................................................... 83
8.18
Novo Berde ............................................................................................................................ 84
8.19
Obiliq...................................................................................................................................... 85
8.20
Peje....................................................................................................................................... 86
8.21
Podujeve ............................................................................................................................... 86
8.22
Prishtine ................................................................................................................................. 87
8.23
Prizren................................................................................................................................... 90
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8.24
Rahovec ................................................................................................................................ 91
8.25
Shtime................................................................................................................................... 92
8.26
Skenderaj .............................................................................................................................. 93
8.27
Shterpce................................................................................................................................ 94
8.28
Suha Reke ............................................................................................................................ 95
8.29
Viti......................................................................................................................................... 96
8.30
Vushtrri.................................................................................................................................. 96
9.
NEXT STEPS ................................................................................................................ 98
1
Continue gathering information .................................................................................................... 98
2
Expert Working Groups and Workshop ........................................................................................ 98
3
Present GIS data to the Working Groups ..................................................................................... 98
4
Prepare several alternative network options for discussion .......................................................... 98
5
Develop Implementation Plan for preferred network..................................................................... 98
6
Prepare Capital Investment priority list......................................................................................... 99
7
Monitoring and Evaluation Plan ................................................................................................... 99
Appendix I – People Interviewed During Data Collection....................................................... 100
Appendix II. Health care facilities in Kosovo ......................................................................... 108
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ACRONYMS
ABO
Average Bed Occupancy
ACSC
Ambulatory Care Sensitive Conditions
ALOS
Average Length of Stay (in hospital)
AMF
Ambulanca or punkt
CCHF
Crimea-Congo hemorrhagic fever
EDL
Essential Drugs List
FMC
Family Medicine Centre
G&S
Goods and Services
GIS
Geographic Information System
H&SW
Health and Social Welfare
HIS
Health Information System
HFRS
Hemorrhagic Fever with Renal Syndrome
ICD
International Classification of Diseases
ICU
Intensive Care Unit
IDP
Internally displaced people
IPH
Institute of Public Health
KA
People using the Kosovo health system
KS
People in Kosovo using the Serbian health system
LGF
Local Government Financing
MEF
Ministry of Economy and Finance
MFMC
Main Family Medicine Centre
MSH
Ministry of Health
NIPH
National Institute of Public Health
PHC
Primary Health Care
QKMF
Main Family Medicine Centre
QKUK
Prishtine University Clinical Centre
QMF
Family Medicine Centre
WHO
World Health Organisation
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EXECUTIVE SUMMARY
This Report presents data gathered during the conducting of interviews with
around 450 people, visits to nearly 130 facilities, departments, and municipal
Health & Social Welfare sections, in 31 municipalities, and subsequent data
analysis.
Semi structured interviews were conducted with the Director of Health & Social
Welfare and other municipality staff in each of these municipalities, and
observations and semi structured interviews with Directors and staff were
conducted in each facility.
Prior to the visits, requests for detailed data in specific areas were provided to
municipalities (14 areas of data); hospitals (53 areas); and main family medicine
centres (24 areas). The facility interviews and observations were structured
around 40 areas which covered the physical structure of the facility and its
suitability for its purpose; the services provided, and how they are provided;
and the resources, both material and human, available to provide these services.
The interviews with municipalities were structured around 20 questions
covering the main health concerns in the municipality and how health and
health management is structured.
Brief consumer surveys are being conducted which concentrate on access and
areas of concern through 8 questions.
The database resulting from these activities will also be available to allow more
detailed study. It should be noted that this Report relies on data gathered from
visits, research and interviews, and documents provided. As in all countries,
people collect data in the same area for different reasons, and so figures
inevitably vary, depending on the data source, especially as there is no unified
collection system for all the types of data we have gathered. Where figures in
this Report differ significantly enough between sources to potentially impact on
planning and network decisions, this is mentioned.
KEY FINDINGS
The following are the key findings that will be taken into account when
designing the Master Plan for Kosovo’s Health Sector.
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1. Population and population movements. There is discrepancy between the
various sources of current population estimates, reflecting the well
acknowledged need for a population census. The vast majority of
municipalities visited reported that the birth rate has reduced dramatically
and that they have a relatively young population which is tending to move
towards the urban centers.
2. Services per population. There is consistency in a number of parameters
regarding the number of services for the population. The number of
hospitals tends to be low compared to other countries (0.5/100,0000),1 as
are the number of primary care doctors (49/100,000), primary care nurses
(138/100,000), acute care hospital beds (177/100,000), however, as in
many countries, there are factors in Kosovo’s health system that mandate
caution in making comparisons.
3. Low Bed Occupancy. Despite the comparatively low total number of
hospital beds, the average percent of time that any one bed has a patient in
it, especially in regional hospitals, is relatively low (around 57%). Again
caution is needed in making comparisons.
4. Work load. In regards to work load, figures are approximate, although there
is consistency across the figures available. The average number of patients
seen by a doctor per day in a main family health center is about 20, with a
range of 10-30. In the smaller facilities the numbers per day tend to be
around 10-15. The workload of nurses is considerably less, around 5-10
patients a day. These figures are low in comparison with other countries.
5. Guidelines. Throughout Kosovo there is ample evidence of dedicated health
professionals performing good quality services. Training bodies for both
doctors and nurses have prepared protocols and guidelines for care, and a
primary care project is currently preparing some additional protocols.
There is only limited evidence however of effective implementation of
clinical guidelines or protocols.
6. Monitoring of quality. There is a mandated structure in place to enable the
Ministry of Health, municipalities, and various groups and committees, to
monitor quality of care. The effectiveness of these programs, without a
comprehensive data collection and formal performance monitoring
program, is mostly questionable. It appears the monitoring in reality is
more focused on processes, disciplinary measures, attendance, and
1
Numbers throughout are based on a population estimate of 2.2million
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complaints, rather than on quality and performance improvement, other
than in a few facilities.
7. Essential Drugs. The lack of drugs supplied from the Essentials Drugs List
was reported to be a problem in all facilities at all levels of care. In 12
facilities monitored, monthly supplies were between 8% and 54% of the
drugs ordered over the last 6 months. There is variation month by month.
Other frequent complaints regarding medication supply were that supplies
were delivered that had not been ordered, or were close to the expiry date.
Some reported that there has been better supply in the last few months
(around 50% of orders in some facilities). It will also be of concern as basic
medications become more available, that pharmaceutical services are
practically nonexistent. No pharmacists are employed in public primary
care facilities, where wise medication use can be most easily influenced, and
virtually no pharmacists in higher levels of care.
8. The lack of emergency drugs is another disturbing aspect of the general
drug supply problems. Random checks were undertaken during the facility
interviews to identify the availability on that day of a basic range of 14
emergency drugs supplied by the Ministry of Health. The Main Family
Medicine Centers had an average of 6.8 of the 14 selected emergency drugs,
with the range being between 3 and 13, and hospitals surveyed had a range
between 7 and 11 of the 14 drugs. Facilities with larger ranges had mostly
topped up the Ministry-supplied drugs from municipal funds. The Prishtine
City Emergency Center is better supplied in this regard, with 13 of the 14
selected drugs being present on the day. Facilities
9. Emergency service vehicles. It is clear that the number and condition of
auto-ambulances are also inadequate for emergency services. Of 100
vehicles identified during site visits only 47 were operational. These were
from a very large variety of manufacturers, and lack of maintenance or
inability to acquire, or pay for, spare parts or servicing was stated as being
the usual reason for non operational vehicles. A number of donated vehicles
were unable to be registered due to lack of documentation. Few auto
ambulances could be regarded as fully equipped to international standards
as an emergency health service vehicle.
10. Location and type of emergency facilities. The structure of emergency
services will be considered as part of the Master Plan. There is generally a
lack of equipment, supplies and training suitable for providing emergency
services at the primary health care level. There needs to be a clear
differentiation between the care that should be provided through 24hr
primary care facilities and the hospital emergency departments. There is
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also an issue with regard to the closely located Prishtina University Hospital
Emergency Department and the City Emergency Center, a facility that is
much newer and better equipped and is under used.
11. Laboratory. All the Main Family Medicine Centres have some capability
with regard to laboratory services, most of the equipment being donated
and from quite a wide variety of manufacturers. There are many examples of
malfunctioning equipment where replacement parts are either unavailable
or too expensive. In a number of examples new equipment has never been
used because of the price of reagents or due to a lack of appropriately skilled
staff. Laboratory equipment in the regional hospitals and the Prishtina
University Center, where it would be expected that test volumes would be
higher, do not consistently have higher volume equipment. A core group of
staff has been trained in maintenance and servicing through a World Health
Organisation initiative, however facilities whose staff did not receive
training are now facing the need to find funds to pay the facilities with
trained staff which are now contracting out these staff.
12. Imaging services are in a similar position. Much of the equipment is
donated, with a variety of manufacturers. The diversity of equipment
suggests there is no consistent strategy regarding what services should be
provided in primary care, and therefore what equipment is required. There
is a CT scanner in QKMF Kline for example, (although it is not functional due
to inappropriate storage). There are three CT scanners at the Prishtina
University Center, however the only one that is reasonably new and capable
of being fully operational is currently non operational due to software
issues.
13. Renal dialysis has clearly been one priority in establishing quality health
services, and is generally in reasonable shape (apart from some lack of
isolation of patients and materials which has probably led to cross
infections). Municipalities also invest a large proportion of their goods and
services budget transporting dialysis patients and may rely on donations to
be able to provide the service. Dialysis is a procedure prone to
complications, and the cleanliness of the surrounding environment and
equipment maintenance is crucial. The largest center for dialysis, at
Prishtina University Center, is located on the 5th floor of building that has
inadequate elevators. There are also indications of infrastructure issues that
will inevitably be resulting in cleanliness and infection control issues.
14. Secondary care infrastructure. Of the 36 hospital departments that were
inspected during the site visits, 7 were in reasonably good overall condition,
with the remainder requiring various degrees of renovation to raise them to
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a reasonable standard. There were several situations, including some clinics
at the Prishtina University Center, where the condition is so poor that it is
unlikely that renovation would be a desirable or cost effective solution.
Attending to maintenance and renovation should in general be a much
higher priority at this stage than investing in new buildings, especially when
a proposal is not accompanied by an in depth needs analysis by independent
sources.
15. Primary care infrastructure. A total of 42 primary care buildings were
identified and inspected. About 30% were in reasonable or good condition,
even if not necessarily built to health care facility standards, while the
remainder required renovation. While over 50% had reasonably effective
heating most of the other parameters, such as seamless floors and effective
clinical waste management, scored much lower, typically only about 2030%. Again maintenance and renovation is a much higher priority than new
construction, except in a very few cases.
16. Human resources and the private sector. It appears that there are high
numbers of unemployed health workers in the municipalities, particularly
nurses. A few areas lack doctors since transport coverage incentives are no
longer paid. The salaries are relatively low (physicians for example receive
247 euro/month). This is causing all health workers who able to, to also
work in the private sector. It was clear during the site visits that most
doctors establish their own, mainly solo, private practices close to the
hospital or in their home. Only in a very few municipalities do the private
health services add anything to the total range of health services available
there.
17. Maternity services. Thirteen main family health centers have well
established maternity units, with a total of 143 beds. There is clearly an
issue with the role of these facilities as the numbers of staff have reduced
over time, especially with regard to a lack of 24 hour gynecologist
availability, and this has caused facilities to restrict their intake. This will
also be addressed specifically in the Master Plan.
18. Financial. Procurement procedures were often mentioned during the
interviews as a significant issue. Maintenance of emergency vehicles was
specifically mentioned as being problematic as often there were not enough
companies tendering to service a variety of vehicles from a variety of
manufacturers, to satisfy legal procurement requirements, thus halting the
process. Hospital managers feel they have at least some ability to manage
their budget, however this is not the case with primary health care
managers, whose budget is mainly managed by the municipality financial
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areas, and it is commonly viewed that their lack of understanding of health
needs also leads to unsatisfactory procurement.
19. Medical records and health information systems. The most common
system in place is the National Institute of Public Health reporting system. A
number of facilities however indicated that they have ceased using the
system for a variety of reasons, with corruption of data being a common
complaint, and the system not meeting clinical and administrative needs,
another. Facilities also complain that they do not receive feedback when
they do submit their data. Some facilities are involved in a Luxembourg
Government-supported project which allows a more physician focused
patient record to be created, and this project is currently being expanded. A
World Bank project is expanding the DataGuard system into 3 project sites.
Coordination with Kosovo-wide strategies for health information is vital if
such activities are to contribute to improved collection of health information
generally.
20. Readiness for accreditation. The site visits and interviews included a
number of questions and observations that are often used in accreditation
assessment internationally. It was clear during the site visits that, even
though some facilities were closer than others, none of the facilities visited
would be assessed as able to be accredited, if international standards are
used.
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1. INTRODUCTION
This Data Report is the second formal Report prepared for the Kosovo Master
Plan Project. It is based on research undertaken in Kosovo during April, May and
June 2008, and on various papers provided by local consultants and stakeholders.
The intent of the Report is to present all relevant data available which can be
used as a basis for recommendations regarding the MasterPlan for Kosovo’s
Health System.
BACKGROUND
The Kosovo Strategic Development Plan and other analytical work identified a
need for information and analysis to strengthen evidence-based decision making
in health planning and capital investment, to manage scarce resources and use
them more efficiently. The Health Law 2004/4 relies on the existence of a
Network Plan of public healthcare institutions for the establishment of
institutions to provide healthcare, including their number and capacity.
Currently, the public sector includes the Prishtina University Clinical Center
(QKUK), 10 regional or city hospitals, a number of specialized facilities and many
primary health care centers.
The lack of a Kosovo Master Plan based on population needs, which can be used
to govern the direction and timing of capital investments in all levels of care, is
resulting in inefficiency in the system. The lack of such as plan also encourages
each facility to try to develop a full range of services, which may not be necessary
for, or supportive of, best care.
OBJECTIVES OF THE MASTER PLAN PROJECT
The Master Plan Project will operate for the remainder of 2008 and will produce
the following objectives:
To support Kosovo in its plan to restructure and rationalize the public health
sector, the overarching objective of the consultancy is to develop, in collaboration
with the Ministry of Health (MSH), a Masterplan / strategy for restructuring health
facilities in the public sector including PHC centers, hospitals and the Prishtina
medical center. The Masterplan/strategy provides a long-term vision with targets
for an efficient, sustainable and equitable health sector; and encompasses networks
and development plans to guide investment and restructuring of health facilities.
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The Masterplan/strategy will take into account overall service affordability within
the limited resource envelop available for the health sector and the Government
goal to create a sustainable and more efficient public sector while improving
equitable access to care through a network of health facilities that ensures a
continuum of care and efficiency-enhancing treatment practice. It will consider
future changes in demand for care given the changing treatment patterns as well as
demographics (aging population) and morbidity changes.
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2. DATA GATHERING ACTIVITIES
To obtain an insight into the overall situation with regard to the Kosovo
healthcare situation, the Consultants undertook various research activities aimed
at obtaining information from a broad variety of sources including the following:

Interviews with 35 staff of Government departments including the Ministry
of Health, National Institute of Public Health, Ministry of Economy &
Financing, and Ministry of Transport

Site visits to all departments and units of the Prishtina University Clinical
Center, five Regional Hospitals; three city hospitals; the tertiary dental
facility; and the Integrated Mental Health Centre, during which assessments
were made of departments in terms of staffing, services, resources and
quality, as well as an assessment of the condition of each of the main
buildings.

Site visits to 43 primary health care facilities including main family
medicine centres, maternity units, family medicine centres, punkts,
community mental health centres and TB units, during which assessments
were made of each functional area in terms of services, staffing, resources
and quality, as well as the condition of the buildings

Interviews with more than 450 primary, secondary and tertiary care health
workers and consumers

Interviews with 30 Municipality Health & Social Services Directorates

Interviews with 7 relevant international agencies with related projects

Analysis of available data from the National Institute of Public Health
(NIPH) and other sources.
Included in the more than 450 people interviewed are those listed in Appendix I.
RANGE OF INFORMATION SOUGHT
The data requests provided to municipalities and health facilities prior to
interview visits sought specific information which could involve extracting data
from the health information system or other facility records. The interviews
allowed more in depth exploration of specific areas and ensured that local issues
and interests could be highlighted and discussed. Observations of the
operations and environments of departments throughout each facility allowed
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us to gather specific data of interest, including through additional interviews
with medical staff. Areas covered in data requests and interviews included the
following.
1. Municipality
A. Data Request:

Estimated current population of Municipality, by settlements

Number of health care facilities by type and location

Numbers and type of medical and non medical staff in primary
health care facilities

Income, including details of requested and received health budget
from MEF and Municipality
B. Interviews:

Local considerations with respect to health care including
geography, social and health conditions

Number and type health workers employed and any unemployed
health workers

Gaps in regard to staffing of health facilities

Budgeting processes and any issues, including procurement

Monitoring of quality of health services

Gaps in health services

Wastage and inefficiencies in health sector
2. Primary health care facility
A. Data Request:

Population catchment area

Number of medical and non medical staff by type

Numbers and types of visits and services, patients per year, and
common diagnoses

Number of patients referred to higher level of care

Numbers of patients seen/doctor
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
Services/nurse

Numbers of emergency patients

Number of imaging services and patients

Number of laboratory services and patients

Number of types of medications in stock

Average medications prescribed/patient

Equipment inventory
B. Interviews:

Population catchment details

Significant local geographic, economic and health circumstances

State of buildings and their functionality as a health facility

Hospitals refer to and access times

Interactions with private sector

Staff hours, service load, training, training needs, motivation and
staffing gaps

Details of facility services including provision of legislated services
and services gaps

Ambulance services including number of vehicles and transport load

Quality improvement activities

Medical records and health information systems

Current and proposed projects

Review of emergency area including emergency drug sampling

Review of XRay and laboratory areas

Pharmacy service including availability of EDL generally
3. Hospitals
A. Data Request:

Layout of buildings including floor space and size of hospital
compound

Organisation Chart and Strategic Plan
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
Staff: numbers and type of medical and non medical staff for total
hospital and by department:

All admissions for most recent year, by department, by ICD 10 code

Numbers of visits, patients, and conditions, at each outpatient clinic,
by ICD 10 code

Number of referrals from feeder facilities

Number of imaging services and patients

Number of laboratory services and patients

Average length of stay for normal delivery

Number of renal dialysis patients and sessions

For (1) the hospital as a whole, and also (2) separated by
department:
o
Number and type of day surgeries
o
Annual post operative infection rate
o
Infections secondary to medical care/year
o
Number readmissions within 24 hours after discharge/year
o
Number readmissions within 28 days after discharge/year
o
Number patients transferred to other facility/year
o
Number of treatment protocols for major conditions
o
Number of transfusions and type

Number of types of medications regularly kept in stock

Number of medications dispensed and average number of
medications/patient on discharge

Equipment inventory – type; manufacturer/model; location; age; if
maintained; if working
B. Interviews:

Catchment area and population served

State of hospital buildings and functionality as a health facility

Departments available and services referred

Services and department gaps

Staff assessment

Management structure and activities including monitoring

Emergency services including ambulance and transport services
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
Current and proposed projects

Assessment of departments of interest
DATA GAPS AND ISSUES
Regarding the data sought, a number of fields were not available, or some
caution is needed in interpreting the figures. These are described below.

Population
No population census has been conducted in Kosovo since 1981. Municipalities
attempt to estimate their population through various means, including using
voter registrations and school enrolments. Some municipalities were able to
provide settlement population estimates. Population data will be clarified to the
extent possible by the GIS consultant.

Population catchment area
Some data is available. Most facilities had originally started registration of
patients, but had ceased due to lack of supply of health cards, or issues with
application or enforcement.

Numbers and type of medical and non medical staff
Staff numbers are a snapshot in time. They also vary depending on the source
and their reason and method for data collection, time lag for updating, and
whether full time equivalents or total people are counted. Figures obtained are
in general accurate enough though for the purposes of Master Planning, with
any areas not so, being further investigated to the extent possible. Resident
doctors are sometimes recorded and sometimes not, as they are paid through a
different budget.

Health budget
Again there are some variations depending on the Municipality’s approach.

Wastage and inefficiencies in health sector
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Wastage and inefficiency is obvious, but awareness of where savings could be
made was not high among the vast majority of those interviewed, being too
overwhelmed day to day by what was not available. A few mentioned an excess
of non medical workers.

Visits, services, patients, common diagnoses, referrals
There is not a common data set, making comparisons difficult, however enough
data is available to assist Master Planning. Although facilities often know the
number of visits and types of services provided, and sometimes a log of patients
is maintained, there is often no longitudinal patient record, so patients may be
counted multiple times in these figures. Most record 1st + 2nd visit for the same
episode as the second visit is not levied for a copayment. Frequently facilities
only record either the services or the patients but not both, and it is sometimes
not clear which is being presented.

Medications and Pharmacy Service
Inventories are available for stock at each facility, with centralized inventories
at each Main Family Medicine Centre (QKMF). Facilities also record medications
ordered and medications received, allowing gaps to be readily calculated.
Facilities do not generally have medication records for patients. Apart from
keeping inventory and handing out medications after entry into the log book,
there are no pharmacy services provided.

Equipment inventory
Although equipment inventory management software is available, at least in
hospitals, record keeping varies considerably, however enough data is available
to give a picture, and we have been able to record laboratory and radiology
equipment in most facilities, during our observation visits.

Admissions for most recent year, by department, by ICD 10 code
Availability of records vary, as does the administrative organization of functions.

Infection rates and readmissions
Most departments do not routinely collect this type of data, used in many
countries as quality measures.
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____________________________________________________________________________ Kosovo Health Master Plan
3. THE CURRENT NETWORK
The current healthcare network in Kosovo includes the following:
SECONDARY AND TERTIARY CARE

1 Tertiary care Hospital, the Prishtina University Center (QKUK), that also
acts as a secondary care facility for the local population and for some
municipalities which do not have a regional hospital

5 Regional Secondary Care Hospitals

5 City Hospitals that are structured similarly to Regional Hospitals but
with a smaller range of services

8 community facilities; 8 integrated houses and 1 Integrated Centre
which provide mental health care additional to hospital psychiatric beds

1 Tertiary Dental Facility

1 Occupational Medicine Institute

10 TB units which include diagnostic centers and 3 TB units without
diagnostic ability

7 Institutes of Public Health.
(It was advised by the Ministry of Health (MSH) that the one of the Occupational
Health facilities is not considered part of the health network.)
PRIMARY CARE

31 Main Family Health Centers, 13 of which have maternity units

154 Family Health Centers

251 Ambulancas/punkts.
The total number of facilities is complicated by the parallel health system
servicing Serbian communities. Some municipalities do not count these facilities
and some do. Serbian facilities have also been separately identified to the extent
this data is available.
Report 2: Data ______________________________________________________________________________________ 21
____________________________________________________________________________ Kosovo Health Master Plan
Sixty-two of the primary care facilities and three of the hospitals listed above are
serving people in Kosovo wishing to use the Serbian health system. The full list
of facilities identified is in Appendix II.
The flow of patients generally follows that of many countries with a reasonably
developed primary care network. In Kosovo, although a patient is assigned to a
particular primary health care (PHC) facility - and sometimes to a particular
doctor - where their health record is kept, it is not mandatory to only visit that
centre. Also, the registration Health Care Cards have not been supplied by the
MSH for some time and most centres have ceased registering patients. Patients
in rural areas generally visit the nearest primary care doctor (ambulanca/punkt AMF), and after hours visit the extended hours (Main) Family Medicine Centre.
Patients in towns tend to visit either the Family Medicine Center assigned, which
may be the Main Family Medicine Center (QKMF), and after hours also visit the
extended hours (Main) Family Medicine Centre. Patients may also have to visit
another facility (usually the Main Family Medicine Centre) for laboratory and
XRay investigations. Some specialists are employed in Family Medicine Centres
(QMF), including a range of specialists not normally found in primary care who
are usually being employed until retirement.
If it is necessary to refer a patient to a higher level of care, a written referral is
required.
Patients can attend a secondary care facility directly without a referral in the case
of an emergency. If it turns out that it is not an emergency then they pay a copayment (assuming that they are not in one of the many co-payment exempt
categories).
Report 2: Data ______________________________________________________________________________________ 22
____________________________________________________________________________ Kosovo Health Master Plan
4.
HEALTH CONCERNS
The Health Priorities Working Group appointed by the MSH is to recommend the
top health priorities for Kosovo. This is to ensure that the Health System
Network provides access to the services needed to address the conditions
causing most problems in Kosovo. All facilities and departments were asked to
provide the top conditions which patients present. Not all facilities collect such
data routinely.
In prioritising diseases a number of factors need to be taken into account
including the prevalence of the condition, the condition’s susceptibility to
prevention and treatment; seriousness of the condition and its impact on the life
of the patient; risk to the general population if the disease is not treated; and the
cost to the patient and community of treating and not treating the condition,
among many other factors.
Information presented here is being used to assist the Working Group’s
deliberations.
REASONS FOR SEEKING PRIMARY HEALTH CARE
The tables below show that a number of conditions are very common in Kosovo
across all three levels of care: Infections including respiratory and throat,
bronchitis, pneumonia and ear; gastroenteritis; hypertension; and diabetes.
Depression and post traumatic stress disorder are reported in other studies in
Kosovo to also cause significant disease burden.
Table 1: Most common reasons for visiting Kacanik primary care facilities
Description
General exam or investigation without
complaint or diagnosis
ICD 10 Code
Number of patients
Z00
5522
Pharyngitis or tonsillitis acute
J02-03
3064
Supervision normal pregnancy
Z34
1227
Hypertension
I10
1164
Influenza
J11
1060
Diarrhoea & gastroenteritis presumed infectious
A09
957
Kyphosis and lordosis
M40
716
L00-L08
634
J00
541
Infections of the skin and subcutaneous tissue
Common cold
Report 2: Data ______________________________________________________________________________________ 23
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Table 1 (continued): Most common reasons for visiting Kacanik primary care facilities
Description
ICD 10 Code
Number of patients
Abnormalities of heart beat
R00
521
J20-21
489
Other medical care
Z51
364
Pneumonia
J12
356
Gastritis & duodenitis
K29
288
Diabetes non insulin dependent
E11
284
Otitis externa
H60
266
Scabies
B86
242
Migraine
G43
229
Varicella
B01
223
Polyarthrosis
M15
227
Bronchitis acute
Table 2: Most common reasons for visiting Mitrovice primary care facilities in March 2008
Description
ICD 10 Code
Number of patients
Acute pharyngitis & tonsillitis
J02-03
974
Potential health hazards; pregnancy & fertility
Z31-33, 37, 55-99
948
Primary hypertension
I10
634
Exams & investigations
Z00-Z13
601
Dorsopathies, spondolopathies, dorslagia
M40-49, 53, 54
378
Influenza
J10,11
339
Diabetes mellitus
E10-14
258
Cystitis
N30
253
Chronic diseases lower respiratory tract
Circulatory & respiratory, nausea & vomiting
J40-44
R00-09, 11-49, 51,
53, 55-99
189
163
Acute bronchitis
J20-21
148
Gastritis and duodenitis
K29
135
Migraine
G43,44
121
Skin disorders
L10-L99
94
Anaemia siderepenica
D50
83
Conjunctivitis
H10-13
75
Laryngitis
J04
72
Abdominal & pelvic pain
R10
71
Infections skin and subcutaneous tissue
Endocrine disorders; fluid & electrolytes,
minerals; obesity; amylodosis
L00-08
E15-35,5863,65,67,85,87-90
66
62
Report 2: Data ______________________________________________________________________________________ 24
____________________________________________________________________________ Kosovo Health Master Plan
Table 2 (continued): Most common reasons for visiting Mitrovice primary care facilities in March
2008
Description
ICD 10 Code
Arthroses
M15-19
Soft tissue disorders
Number of patients
M60-79
S00, 04,09-11, 14,
16,
Injuries & wounds
Diarrhoea & gastroenteritis
A09
URTI
J00,01,05,06
H60-62, 80-83, 9295
Diseases external & inner ear
Antenatal services
Z34-36
53
53
53
47
46
39
39
Table 3: Most common reasons for visiting Gjilan Main Family Medicine Centre (QKMF)
Description
ICD 10 Code
Common cold
J.00
Acute tonsillitis
J.03
Hypertension
I10
Dorsalgia
M54
Non insulin dependent diabetes
E11
Calculus of kidney and ureter
N20
Table 4: Most common reasons for visiting Gjakove QKMF
Description
Urinary tract infection
Renal colic
Biliary colic
Tonsillitis/pharyngitis
Bronchitis
Hypertension
Headache
Diabetes
Diarrhoea
Sinusitis
Otitis
Myalgia
Polyarthrosis
Report 2: Data ______________________________________________________________________________________ 25
____________________________________________________________________________ Kosovo Health Master Plan
Gastritis
Hernia
Injuries including burns
Allergy
Cardiomyopathy
Hyperlipidemia
NUMBER OF INSULIN DEPENDENT DIABETICS & HAEMODIALYSIS PATIENTS
Renal disease and diabetes management were common topics of discussion in
the interviews, mainly because of the problems with obtaining insulin supplies
and the health and financial impact this has on their patients, and because of the
financial and resource load that transporting dialysis patients poses for primary
health care. Table 5 shows the number of patients in each municipality with
insulin dependent diabetes and the number of patients in each municipality who
are undergoing dialysis.
People in municipalities with dialysis units often do not know the number of
patients being dialyzed in their Unit who are from their municipality. The total
number of people undergoing dialysis in Kosovo is around 548. Over 3634 rely
on insulin.
Table 5: Insulin dependent diabetics and haemodialysis patients in each municipality
Municipality
Insulin
dependent
Dialysis
patients
Dialysed in
Decan
97
11
Peje
Dragash
60
10
Prizren
153
35
Gjilan
89
7
Ferizaj
Fushe Kosove
Dialysis patients/
dialysis centre
Prishtine
Gjakova
351
Gjakova
31
Gjilan
210
Gjilan
96
Gllogoc
Hani I Elezit
13
Prishtine
9
4
Gjilan
Istog
80
16
Peje
Junik
18
0
Kacanik
33
8
Gjilan
Kamenice
60
6
Gjilan
Kline
65
13
Peje
Lipjan
90
8
Prishtine
Report 2: Data ______________________________________________________________________________________ 26
____________________________________________________________________________ Kosovo Health Master Plan
Table 5 (continued): Insulin dependent diabetics and haemodialysis patients in each municipality
Municipality
Insulin
dependent
Dialysis
patients
Dialysed in
Malisheve
60
16
Mamushe
3
0
Mitrovice Sth
Novoberde
Obiliq
173
2
Prizren
Mitrovice
2
34
Dialysis patients/
dialysis centre
76 (11 in Nth
Mitrovice)
Gjilan
6
Prishtine
80
Peje
389
Podujeve
171
22
Prishtine
Prishtina
610
50
Prishtine
150
Prizren
316
Prizren
138
Rahovec
83
26
Prizren
Shterpce
6
1
Gjilan
Shtime
29
9
Prishtine
Skenderaj
57
18
Mitrovice
Suhareke
101
30
75
22
Gjilan
210
19
Mitrovice
Viti
Vushtrri
Peje
Serbian patients Belgrade
REASONS FOR SEEKING OUTPATIENT CARE AT QKUK
Table 6: Most common reasons for Outpatient Visit at QKUK
ICD description
Hypertensive heart disease
Essential (primary) hypertension
Non-insulin-dependent diabetes mellitus
Dyspepsia
Iron deficiency anaemia
Spondylosis
Angina pectoris
Acute myocardial infarction
Chronic ischaemic heart disease
Gastritis and duodenitis
Haemorrhoids
Seropositive rheumatoid arthritis
Acute renal failure
Insulin-dependent diabetes mellitus
ICD code
I11
I10
E11
K30
D50
M47
I20
I21
I25
K29
I84
M05
N17
E10
Number of patients
4680
3300
2545
2520
1800
1603
1540
1166
1000
668
652
627
589
531
Report 2: Data ______________________________________________________________________________________ 27
____________________________________________________________________________ Kosovo Health Master Plan
Table 6 (continued): Most common reasons for Outpatient Visit at QKUK
ICD description
Duodenal ulcer
Gonarthrosis [arthrosis of knee]
Polycythaemia vera
Reactive arthropathies
Other functional intestinal disorders
Myeloid leukaemia
Congenital hypothyroidism with diffuse goitre
Chronic renal failure
Thyrotoxicosis with diffuse goitre
Tubulo-interstitial nephritis, not specified
Other specific arthropathies
Systemic lupus erythematosus
ICD code
K26
M17
D45
M02
K59
C92
E03.0
N18
E05.0
N12
M12
M32
Number of patients
520
497
400
335
322
300
300
274
200
167
154
150
REASON FOR ADMISSION - SECONDARY CARE
The top reasons for seeking care in hospitals are in many cases the same as in
primary care. In addition, many of the top conditions (such as hypertension,
diabetes, nutritional disorders, asthma, diarrhoea, tonsillitis/pharyngitis) are
those classified as Ambulatory Care Sensitive Conditions which, if managed well
in primary care, should be seen in much smaller numbers in hospital.
Table 7: Most common reasons for admission to Prizren Hospital
Description
Essential (primary) hypertension
Streptococcal tonsillitis
Asthma
Diarrhoea & gastroenteritis presumed infectious
Chronic diseases of tonsils and adenoids
Acute pharyngitis
Acute nasopharyngitis (common cold)
Cutaneous abscess
Pneumonia
Spondylosis
Amnesia, not induced by alcohol etc
Chronic renal failure
Cholelithiasis
Calculus of lower urinary tract
Inguinal hernia
Gastritis and duodenitis
ICD code
I10
J03
J45
A09
J35
J02
J00
L02
J18
M47
F04
N18
K80
N21
K40
K29
Number of patients
1948
1828
1239
1196
960
906
876
800
743
708
700
664
611
589
503
498
Report 2: Data ______________________________________________________________________________________ 28
____________________________________________________________________________ Kosovo Health Master Plan
Table 7 (continued): Most common reasons for admission to Prizren Hospital
Description
Gonarthrosis [arthrosis of knee]
Acute bronchiolitis
Bronchitis, not specified as acute or chronic
acute laryngitis
Blepharitis
Hyperplasia of prostate
Dorsalgia
Other intervertebral disc disorders
ICD code
M17
J21
J40
J04
H10
N40
M54
M51
Number of patients
497
491
478
469
467
466
449
448
SECONDARY + TERTIARY CARE - SOME QKUK DEPARTMENTS
Table 8: Most common reasons for admission - QKUK Cardiology Department & Coronary Care Unit
Description
Acute myocardial infarction
Essential (primary) hypertension
Acute myocardial infarction
Non-insulin-dependent diabetes mellitus
Heart failure
Essential hypertension, Ischaemic
cardiomyopathy, Hypertensive heart disease
Angina pectoris
Bronchitis
Cardiomyopathy
Old myocardial infarction
Cardiomyopathy
Cardiac arrest
Atrial fibrillation and flutter
Atrial fibrillation and flutter
Clinic name
CCU
Cardiology 1+2
Cardiology 1
Cardiology 1+2
Cardiology 1
Cardiology 1+2
Cardiology 2
Cardiology 1+2
Cardiology 2
Cardiology 1
CCU
Cardiology 2
Cardiology 1
CCU
ICD code
I21
I10
I21
E11
I50
I10,I11,
I42.8
I20
J40,J42
I42
I25.2
I42
I46
I49
I49
Number of patients
686
248
168
150
140
116
112
100
89
70
49
35
30
30
Table 9: Most common reasons for admission to Endocrinology Department
ICD description
Iodine-deficiency-related multinodular (endemic) goitre
Cardiomyopathy
Iodine-deficiency-related diffuse (endemic) goitre(? E01.0)
Cerebral palsy
Acute myocardial infarction
Chronic renal failure
ICD code
E011
I42
E010
G80
I21
N18
Number of patients
280
114
80
75
30
22
Report 2: Data ______________________________________________________________________________________ 29
____________________________________________________________________________ Kosovo Health Master Plan
Table 9 (continued): Most common reasons for admission to Endocrinology Department
ICD description
Hereditary nephropathy, not elsewhere classified
Gastritis and duodenitis
Other hypothyroidism
Thyrotoxicosis [hyperthyroidism]
Spondylosis
Other nontoxic goitre
Other mononeuropathies
Hemiplegia
Malignant neoplasm of liver and intrahepatic bile ducts
Idiopathic thrombocytopenic purpura
Cushings Syndrome
Subclinical iodine-deficiency hypothyroidism
Obesity
Nutritional and metabolic disorders in diseases classified
elsewhere
Other endocrine disorders
ICD code
N07
K29
E03
E05
M47
E04
G58
G81
C22
D84
E24
E02
E66
Number of patients
21
20
16
16
16
15
12
12
10
10
10
9
8
E90
E34
8
7
Table 10: Most common reasons for admission to Gastroenterology Department
ICD description
Gastric ulcer
Fibrosis and cirrhosis of liver
Gastritis and duodenitis
Other diseases of stomach and duodenum
Duodenal ulcer
Inguinal hernia
Gastritis and duodenitis
Malignant neoplasm of liver and intrahepatic bile ducts
Other diseases of digestive system
Malignant neoplasm of rectum
Malnutrition-related diabetes mellitus
Other pulmonary heart diseases
GORD
Crohn's disease [regional enteritis]
Other functional intestinal disorders
Malignant neoplasm of colon
Ulcerative colitis
Cholecystitis
Acute pancreatitis
Malignant neoplasm of small intestine
ICD code
K25
K74
K29
K31
K26
K40
K29
C22
K92
C20
E12
I27
K21
K50
K59
C18
K51
K81
K85
C17
Number of patients
160
110
100
100
80
60
50
30
23
20
20
20
20
20
20
15
15
15
15
10
Report 2: Data ______________________________________________________________________________________ 30
____________________________________________________________________________ Kosovo Health Master Plan
Table 10 (continued): Most common reasons for admission to Gastroenterology
Department
ICD description
Malignant neoplasm of pancreas
Malignant neoplasm of other and ill-defined digestive organs
Mental and behavioural disorders due to volatile solvents
Oesophagitis
ICD code
C25
C26
F18
K20
Number of patients
10
10
10
10
Table 11: Most common reasons for admission to Haematology Department
ICD description
Iron deficiency anaemia
Multiple myeloma and malignant plasma cell neoplasms
Follicular [nodular] non-Hodgkin's lymphoma
Acute myeloid leukaemia
Vitamin B12 deficiency anaemia
Disease of blood and blood-forming organs, unspecified
Hodgkin's disease
Chronic myeloid leukaemia
Idiopathic thrombocytopenic purpura
Thrombocytopenia, unspecified
Chronic lymphocytic leukaemia
Other aplastic anaemias
Chronic congestive splenomegaly
Malignant neoplasm of adrenal gland (C74)
Hereditary factor VIII deficiency
Acute lymphoblastic leukaemia
Acquired haemolytic anaemia
Unspecified diabetes mellitus
ICD code
D50
C90
C82
C92.0
D51
D75.9
C81
C92.1
D69.3
D69.6
C91.1
D61
D73.2
C74.6
D66
C91.0
D59
E14
Number of patients
104
45
35
33
31
29
21
19
16
15
12
10
9
8
8
6
6
6
Table 12: Most common reasons for admission to Nephrology Department
ICD description
Chronic tubulo-interstitial nephritis
Chronic renal failure
Unspecified diabetes mellitus
Acute renal failure
Nephrotic syndrome
Cyst of kidney, acquired
Glomerular disorders in diseases classified elsewhere
Obstructive and reflux uropathy
Chronic gastritis, unspecified
ICD code
N11
N18
E14.2
N17
N04
N28.1
N08
N13
K29.5
Number of patients
149
114
52
37
13
12
8
8
7
Report 2: Data ______________________________________________________________________________________ 31
____________________________________________________________________________ Kosovo Health Master Plan
Table 12 (continued): Most common reasons for admission to Nephrology Department
ICD description
Insulin-dependent diabetes mellitus
Essential (primary) hypertension
Acute tubulo-interstitial nephritis
Calculus of kidney with calculus of ureter
Hypertensive heart and renal disease with renal failure
Cardiomyopathy
Systemic lupus erythematosus with organ or system involvement
Septicaemia unspecified
Chronic tubulo-interstitial nephritis
Small kidney, unspecified
Malignant neoplasm of kidney, except renal pelvis
Other metabolic disorders
Pericarditis in other diseases classified elsewhere
Embolism and thrombosis of unspecified vein
ICD code
E10
I10
N10
N20.2
I13.1
I42
M32.1
A41.9
N11
N27.9
C64
E88
I32.8
I82.9
Number of patients
6
5
5
5
4
3
3
2
2
2
1
1
1
1
Table 13: Most common reasons for admission to Rheumatology Department
ICD description
Seropositive rheumatoid arthritis
Spondylosis
Other dorsopathies, not elsewhere classified
Polyarthrosis
Reactive arthropathies
Inflammatory polyarthropathy
Systemic lupus erythematosus
Spondylosis
Dorsalgia
Osteoporosis without pathological fracture
Gonarthrosis [arthrosis of knee]
Behcet's disease
Other intervertebral disc disorders
ICD code
M05
M47
M53
M15
M02
M06.4
M32
M47
M54
M81
M17
M35.2
M51
Number of patients
109
69
21
18
16
10
9
7
7
7
6
6
6
Table 14: Most common reasons for admission – 6 of the QKUK Clinics
Description
Acute myocardial infarction
Oesophagitis, gastritis, duodenitis, ulcers
Disorders of thyroid gland
ICD code
Number patients
I21
884
K20, 21, 25, 29, 29.5, 31
E00-07
547
421
Report 2: Data ______________________________________________________________________________________ 32
____________________________________________________________________________ Kosovo Health Master Plan
Table 14 (continued): Most common reasons for admission – 6 of the QKUK Clinics
Description
Renal disorders
ICD code
N04, 07, 08, 10, 11, 13, 17, 18, 20.2,
27.9. 28.1
Rheumatoid & arthroses etc
Other GI & organ disorders
Cardiomyopathy
M02, 05, 15, 17, 32, 32.1, 35.2
K40, K50, 59, 74, 81, 85, 92
I42
Essential (primary) hypertension
Diabetes mellitus
Lymphomas & leukaemias
Nutritional anaemias & other nutritional
disorders
Heart failure
Spondylosis & disc disorders
Angina pectoris
Malignant neoplasm of GI tract & organs
Other anaemias and blood diseases
Bronchitis
Number patients
398
355
278
315
I10-15
313
E10-E14
234
C81, 82, 90, 91.0. 91.1, 92.0, 92.1
171
D50, 51, E90
I50
143
140
M47, 51, 53, 54
126
I20
112
C17, 18, 20, 22, 25, 26, 64, 74.6
D59, 61, 66, 69.3, 73.2, 75.9, 84
J40,J42
104
103
100
Report 2: Data ______________________________________________________________________________________ 33
____________________________________________________________________________ Kosovo Health Master Plan
5. FINDINGS – INFRASTRUCTURE
POPULATION AND POPULATION MOVEMENTS
It is well known that there has not been an official population census in Kosovo
since 1981. Municipalities attempt to estimate their populations, and there are
official population estimates built into legislation2 which can differ markedly from
local estimates (see 15).
Table 15: Population Estimates
Municipality
Decan
Dragash
Ferizaj
Fushe Kosove
Gjakova
Gjilan
Gllogoc (Drenas)
Municipality
estimates 2006
2008 local
estimates
% difference local &
MEF estimates
65000
46000
40400
35000
65000
35000
60.89
0
144351
111000
160000
44.14
41412
33682
60000
78.14
153000
142845
115000
100348
150000
135000
30.43
34.53
81847
60000
81000
35
18642
18642
10000
44000
9600
33000
12000
60000
12500
50000
20
36.36
30.21
51.52
21.01
70.45
Gracinice
Hani I Elezit
Istog (Burim)
Junik
Kacanik
10000
64342
Kamenice
Kline
Kllokot
57000
59035
49581
44000
4542
60000
75000
Leposavic
19000
19000
19000
Lipjan
88887
69115
82000
18.64
Malisheve
65000
52000
100000
92.31
6000
6000
20000
20000
142200
90000
100000
11.11
3950
9899
5000
-49.5
32500
26000
40000
53.85
43000
Mamushe
Mitrovice Nth
Mitrovice Sth
Novoberde
Obiliq (Kastriot)
Partesh
Peje
2
2008 Law on LGF
estimates
5217
160000
115000
318000
176.5
Eg Law on Local Government Finance Law No 2008/ for General Grant purposes
Report 2: Data ______________________________________________________________________________________ 34
____________________________________________________________________________ Kosovo Health Master Plan
Table 15 (continued): Population Estimates
Municipality
Podujeve
(Bresiane)
Municipality
estimates 2006
2008 Law on LGF
estimates
2008 local
estimates
% difference local &
MEF estimates
127100
117000
120000
2.564
Prishtina
355000
388561
500000
28.68
Prizren
249614
214963
250000
16.3
Rahovec
75000
63000
80000
26.98
Shterpce
16000
11000
15000
36.36
Shtime
35000
28000
35000
25
Skenderaj
73100
56000
72000
28.57
Suhareke
85000
80000
85000
6.25
Viti
69200
46458
70000
50.67
40
Ranillug
Vushtrri
4955
105804
75000
105000
Zubin Potoc
15000
15000
15000
Zvecan
Total Kosovo
population
16000
16000
16000
2,641,187
2,236,963
3,027,142
35.32%
Notes:
1. italics= data not yet received – the municipality’s 2006 estimate is used, or when not available, MEF
2008 Law estimates
2. Under new structure new municipalities (Kllotok, Partesh & Ranillug (populations included with
current municipality) Gracinice, Nth Mitrovice); plus Novoberbe gains settlements (and population)
currently part of Kamenice and Gjilan
Despite reporting significantly lowered birth rates over the past few years and
high rates of migration, many Municipalities also report that their population is
increasing and most believe the current Financing estimates are an
underestimate of their population (average 35%). Municipalities also generally
report a movement of population to their main city from the rural areas due to
lack of infrastructure or employment opportunities, however many still have
significant percentages of their population living in rural areas. Municipalities
also generally describe their population as young with a large percentage of
unemployed people, except for those municipalities with pockets of minority
groups described as elderly.
Most municipalities report reasonable access to some type of primary care, if not
necessarily the full range of primary care services available in the QKMF, with
laboratory, XRay and specialist services available 6-8 hour there, and
consultations available 24 hours. Punkts, staffed 5 days a week for 6-8 hours by a
Report 2: Data ______________________________________________________________________________________ 35
____________________________________________________________________________ Kosovo Health Master Plan
nurse, and mostly 1-3 days a week by a doctor, are widely accessible, but offer a
reduced range of services. The longest time reported to travel to the Main Family
Medicine Centre is in Mitrovice and Drenas, where a couple of villages are 40-60
minutes away, mainly due to poor roads. The furthest village from hospital care
reported was in Dragash (2 hours).
For purposes of setting parameters for the health network, the Law on Local
Government population estimates will be used as the denominator, and the
relatively young average age of the population will be taken into account when
estimating service needs into the future. However for municipalities where local
population estimates vary significantly from official estimates (eg Peje,
Malisheve, Kline, Fushe Kosovo, Decan, Viti, Obiliq), current service use will be
specifically checked to ensure no disadvantage impacting health will result from
using the smaller population estimate.
CAPITAL INVESTMENT
In almost all municipalities we inspected there was evidence of new construction
taking place in regional hospitals and/or primary care facilities. It appears to be
easier to obtain funding for the construction of new facilities than it is to improve
and maintain existing facilities. In a number of relatively newly constructed
buildings there is already evidence of poor maintenance and infrastructure
failure, for example new buildings connected to already inadequate water and
drainage systems. There have also been many renovations seen where the logic
of the choice of renovation project is not immediately apparent, as it seems not to
have improved the particular underlying situation.
It is clear that much of the work is not well planned and possibly not well
executed. The apparent lack of ongoing maintenance budget and sometime even
staffing for the buildings would suggest that they will rapidly deteriorate. The
problem is reflected in the relatively high percentage of the health budget
assigned to capital investment in Kosovo compared with other countries. It is
acknowledged that there needed to be substantial investment in buildings after
the war, however the choice of which buildings to invest in now seems to be
based on parameters other than facility-level needs analysis or Kosovo-wide
prioritization of need.
Also of concern are indications that renovations and building work are
substandard, with many recent renovations already showing signs of poor work,
and also not being designed to health care facility standards with respect to
flooring, furnishings and wall finishes, for example.
Report 2: Data ______________________________________________________________________________________ 36
____________________________________________________________________________ Kosovo Health Master Plan
ASSESSING SUITABILITY AS A HEALTH FACILITY
Drainage problems, leaking pipes, leaking roofs and heating problems were the
main concerns about buildings for facility managers. A number of AMF do not
have drainage or water at all. Also of concern to us were the number of facilities
with floor and wall surfaces that were impossible to properly clean and disinfect.
During the interview/site visit process undertaken through this Project a large
number of areas were inspected, some of which related to issues that are
commonly raised during accreditation inspections. The process included the
development of a checklist for use by all the project personnel undertaking the
visits. There were 20 questions that related to the infrastructure and
maintenance of the buildings, such as whether electrical wiring is covered, as
well as internal management, such as whether clinical waste is properly
managed. Inspections were made of the exterior of each building as well as the
condition of the interior of each building on all levels.
Light bulbs were generally covered, no smoking policies were mostly observed,
and only a few facilities had exposed electrical wiring, or jagged surfaces.
However only a handful of facilities had intact seamless floors and washable
walls. Even newly built facilities have put in floors which were not easily cleaned
and collected dirt.
As an average the QKUK clinics potentially complied with 6 out of the 20 issues.
The range was broad however with 2 building scoring zero while others scored
15 out of 20. There were several examples seen here of clinical waste being left
for many hours in open waste bins in public areas.
HEATING, COOLING, AND GENERATORS
Few facilities had airconditioning (less than 10%), and those that did were
mostly in specific areas. Around 65% facilities had heating, but often it is not
used due to fuel costs. Some facilities had reverted to coke heating due to this
problem. Many facilities had basic firefighting equipment - fire extinguishers,
which would be inadequate for serious fires, and only a handful had smoke
alarms.
The existence of backup generators is less frequent in primary care than in
secondary and tertiary care facilities, about 40% of PHC facilities having working
generators. Sometimes a generator is available, but is not used because of fuel
Report 2: Data ______________________________________________________________________________________ 37
____________________________________________________________________________ Kosovo Health Master Plan
costs, or it is used only to power restricted areas such as operating theatres,
dialysis unit, maternity, ICU, for example.
DRAINS AND WATER
Just over half the buildings viewed had access to hot water and many facility
areas and departments did not have access to soap, let alone antiseptic
handwashing facilities.
Only 28% of facilities reported that they had adequate drainage. Drainage
problems were frequently poor enough to have caused the closing of some toilets
and many other toilet areas being used showed symptoms of poor drainage.
Water supply is also a problem in a number of facilities, either not being
connected at all, or not having a reservoir, or not having pipes to connect the
reservoir.
Addressing these basic safety issues is a priority.
CLEANING AND MAINTENANCE OF HEALTH FACILITIES
The quality of overall cleaning and maintenance is quite inadequate in the
majority of facilities. Of the almost 80 separate buildings that were identified
throughout the site visits (across all levels of care) the number of buildings
where maintenance of floors, walls and windows etc were adequate for infection
control was only a handful. In addition to this, in a number of facilities clinical
waste was evident in public areas for many hours of the day. In some facilities it
was obvious that they were devoting the materials and staff they had to keeping
ward areas clean over keeping general access areas clean, which is a reasonable
approach with limited resources, but certainly has flow on effects for general
hygiene, and is not a sustainable solution.
Overall, we considered that only 50% of the facilities could be regarded as clean
to health facility standards. Reasons for the current situation are many, including
the low salaries of cleaners, lack of cleaning staff, lack of appropriate equipment,
unsuitable surfaces, lack of protocols, and lack of supervision. To remedy many of
these issues requires a relatively small amount of investment in supplies and
equipment, and appropriate management.
Report 2: Data ______________________________________________________________________________________ 38
____________________________________________________________________________ Kosovo Health Master Plan
STRUCTURES FOR MONITORING HEALTH QUALITY
The structures for monitoring the quality of delivery of health services have been
established in both Main Family Medicine Centres and hospitals. These
structures have usually been mandated by regulation centrally and consist
mainly of multiple committees which allow input from different groups of staff
from team and department level to Board level. In small organizations such as
Main Family Medicine Centres the committee structure becomes more topics
based. Committees usual cover:







Discipline
Complaints
Inventory
Quality
Professional matters
Ethics
Committees covering different professional areas.
Quality coordinators form part of these structures in all municipalities. Discussion
about the activities of these committees indicate they are focused more on
discipline and investigating complaints than quality improvement, although a few
facilities are using this structure in more innovative ways, for example, by
conducting patient satisfaction surveys.
In very few situations are the day to day use of clinical guidelines, protocols or any
form of clinical performance indicators evident. Many facilities are aware of the
availability of guidelines but lack the funding to print and distribute them.
The MSH has a team of inspectors who have a checklist of items to inspect to
ensure that structures and processes are in place, including:
 Formation of committees and
commissions
 Existence of rules and
procedures
 Employee evaluation
 Licenses
 Laws and standards
 Sterilization
 Appropriate protective clothing
 Patient information
 Complaints box
 Emergency plan
 Waiting list management
 Intrahospital and other
infections
 Waste management
 Hygiene management
 Medical records and security
 Drug inventory management
 Identity cards
 Training and education
 Disciplinary procedures
 Valuables security
 Access to facility
Report 2: Data ______________________________________________________________________________________ 39
____________________________________________________________________________ Kosovo Health Master Plan




Referral system
Medical protocols
Ethics code
Confidentiality
 Work hours
 Health information system
 Quality of equipment and materials.
PRIVATE SECTOR ISSUES
The interaction between the public and private sectors is very important and in
order to understand the private sector better, efforts have been made to gather
information on the sector during the site visits. People interviewed mentioned
143 private facilities specific to their areas, some of which are not licensed. The
MSH has a list of around 600 registered private facilities.
It rapidly became apparent during the visits that the low salaries paid to the
public health sector employees (247 euro per month to doctors), combined with
the approval for public sector doctors to be employed in the private sector for 4
hours per day, have resulted in almost 100% of specialist doctors, many non
specialist doctors and some nurses working in the private sector. It appears that
most doctors establish their own solo practices located either close to the hospital
or in their private houses.
It is only rarely that the private services add to the total range of services available
in the area.
This duplication has the potential to interact with the public sector in a number of
ways. There may well be situations where the doctors use their public sector
employment to identify patients who may be prepared to receive care in the
private sector. This is not necessarily bad unless the doctor withholds his/her
services from the public sector in order to drive people towards their private
practice. There is also incentive to avoid repairing and supplying reagents and
other material for equipment in the public sector, or even worse, deliberately
damaging equipment, in order to push patients towards the private sector. It
should be noted that this was not identified in the site visits, but the incentive is
there.
The solution to this is complex in that it inevitably needs to involve raising the
salary of health care professionals to a point where engagement in private
practice can be much more controlled and monitored. As salaries are such a
large percentage of the health budget (Table 28), this would involve substantially
increasing the health budget.
Report 2: Data ______________________________________________________________________________________ 40
____________________________________________________________________________ Kosovo Health Master Plan
6.
FINDINGS –– ACTIVITIES
PRIMARY HEALTH CARE SERVICES
The Kosovo Health Law No 20044 specifies certain types of services that should
be provided through primary care:








Promotion, prevention, treatment and rehabilitation of diseases, disorders
and injuries
Health education
Immunization
Initial diagnosis and basic health care including minor surgeries
Promotion of oral health and basic dental health care
Community based mental health care
Community based rehabilitation
Provision of qualitative food and water.
The legislation does not specify that each and every primary care facility should
provide these services, rather that these services are made available. This being
the case then the current network as described in this Report does provide the
legally required services. Immunization for example is not provided in every
punkt, but patients do have access to the service through a visiting team or the
QKMF.
Minor surgery does take place in primary care however in some situations seen
during the site visits the required equipment and consumables, such as local
anaesthetic and sutures are not available in the primary care clinics, so patients
have to separately purchase those supplies.
Further details of appropriate primary care services are described in regulations.
An assessment of 48 primary health care facilities, including 23 QKMF, 13 QMF,
and 12 AMF found the offering of the following services outlined (Table 16). Apart
from these services, in the QKMF - and in a few of the very large municipalities in
some QMF -some other specialist services are available, the most common being
internal medicine, ORL, ophthalmology, pulmology and occupational medicine.
The vaccination unit frequently has an epidemiologist. Some QKMFs have a
psychologist. In addition the majority of QKMFs transport patients for dialysis and
some provide maternity units.
Report 2: Data ______________________________________________________________________________________ 41
____________________________________________________________________________ Kosovo Health Master Plan
Table 16: Services provided in primary health care
Service
Main Family Medicine
Centre
Number
Available in
% of facilities
Family Medicine Centre
Punkt
Number
Available in
% of facilities
Number
Available in
% of facilities
Antenatal Care
23
100%
12
92%
0
0
Vaccination
23
100%
9
70%
0
0
Pharmacy
22
96%
7
54%
0
0
Laboratory
22
96%
4
31%
0
0
Emergency
20
87%
2
15%
0
0
Health promotion
19
83%
1
8%
0
0
Family medicine
18
78%
13
100%
12
100%
Doctor home visits*
18
78%
2
15%
0
0
Home nursing visits*
18
78%
2
15%
0
0
Radiology
17
74%
0
0
0
0
Pediatrics
16
70%
8
61%
0
0
Ob/gyn consult
12
52%
2
15%
0
0
3
13%
0
0
0
0
Dental services
12
52%
9
69%
0
0
Palliative Care
11
48%
1
8%
0
0
3
13%
0
0
0
0
2
9%
0
0
0
0
Occupational medicine
School based dental
services
School based medical
services
*Home visits are always a team of doctor/ nurse/ driver. No separate home nursing is provided
Table 17: Primary care consultations and referrals
Municipality
Decan
Dragash
Ferizaj
Fushe Kosovo
Gjakova
Gjilan
Gllogovc (Drenas)
Hani I Elezit
Istog
Junik
Total number
doctor visits/yr
346087
95326
27605
74760
87048
131586
111,784
192802
9615
Total other
services
219563
5868
209589
114146
210353
# total
referrals/yr
# emergency
cases/day
387
16278
43
10677
31841
36
9
5808
45
10739
Report 2: Data ______________________________________________________________________________________ 42
____________________________________________________________________________ Kosovo Health Master Plan
Table 17 (continued): Primary care consultations and referrals
Municipality
Kacanik
Kamenice
Kline
Leposavic
Lipjan
Malisheve
Mamushe
Mitrovica Sth
Novoberde
Obiliq
Peje
Podujeve
Prishtina
Prizren
Rahovec
Shterpce
Shtime
Skenderaj
Suha Reka
Viti
Vushtrri
Zubin Potoc
Zvecan
Gracanica
Mitrovice Nth
Total number
doctor visits/yr
54877
Total other
services
# emergency
cases/day
20
68615
45
15
65004
1721
50784
417145
152459
216788
50478
1550
104747
227760
2,408,908
Total
# total
referrals/yr
70
506826
128927
26494
43
10
90
86467
1000
5926
10
45
12413
45
94,546
av 37/day
818,117
Table 18: Primary care services – laboratory and radiology
Municipality
Decan
Dragash
Ferizaj
Fushe Kosovo
Gjakova
Gjilan
Gllogovc (Drenas)
Hani I Elezit
Istog
# lab tests/yr
89994
4668
10855
62129
# lab patients/yr
4800
12600
21905
# radiology tests /yr
57000
12600
# radiology patients/yr
12000
4560
4560
6362
24007
16800
0
1606(dental)
0
589
4800
12000
2700
Report 2: Data ______________________________________________________________________________________ 43
____________________________________________________________________________ Kosovo Health Master Plan
Table 18 (continued): Primary care services – laboratory and radiology
Municipality
Junik
Kacanik
Kamenice
Kline
Leposavic
Lipjan
Malisheve
Mamushe
Mitrovica Sth
Novoberde
Obiliq
Peje
Podujeve
Prishtina
Prizren
Rahovec
Shterpce
Shtime
Skenderaj
Suha Reka
Viti
Vushtrri
Zubin Potoc
Zvecan
Gracanica
Mitrovice Nth
Total
# lab tests/yr
591
# lab patients/yr
# radiology tests /yr
# radiology patients/yr
7000
12000
4500
36000
444
49411
70426
77838
14000
7200
7592
14400
39000
9600
7227
39410
4800
1705
12844
3600
3600
10000
5000
7200
7200
14400
54000
7500
449,474
303,940
196,702
66,698
MATERNITY BEDS
A decision was obviously made some years ago to develop a primary care
maternity capability for routine deliveries. Prior to this, a significant number of
women did not receive antenatal care and delivered at home. During the
antenatal visits to these Units, potentially problematic pregnancies are largely
identified and these are referred for hospital supervision and delivery. Making
antenatal care and monitored delivery readily accessible is important in
continuing to reduce Kosovo’s maternal and perinatal mortality rates.
Acknowledging that these Units deal only with normal deliveries, many of these
facilities compared favourably with maternity departments in some hospitals,
Report 2: Data ______________________________________________________________________________________ 44
____________________________________________________________________________ Kosovo Health Master Plan
with regard to equipment, surroundings, cleanliness and suitability as a maternity
unit.
We have visited the 13 primary care based maternity units (3 of which are not
official maternity units) that have a total of 143 maternity beds. Discussions held
with the staff of these units suggest that the attitude to primary care maternity
beds has changed somewhat as numbers of deliveries have fallen, and of recent
time the staff numbers have been reduced, some beds have been closed and
funding for 24 hour gynecologist services is not always available. All but 1 (Viti)
has a gynecologist on call, but the gynecologist serving another unit (Podujeve)
lives 35 km away.
REGIONAL HOSPITAL STATISTICS BY DEPARTMENT
Table 19: Ferizaj Hospital
# residents
#
nurses
FERIZAI
# Beds
Discharges
Bed days
ALOS
ABO
# doctors
Gynecology
21
2450
2563
1.30
31.40%
6
22.5
Internal Diseases
14
173
2029
11.70
40.20%
5
14
Pediatrics
16
540
1196
5.00
29.30%
6
14
Surgery
16
875
1518
2.20
25.90%
2
14
TOTAL
64
4038
7306
1.81
31.28%
19
65
Table 20: Gjakova Regional Hospital
GJAKOVA
# Beds
Discharges
Bed days
ALOS
ABO
# doctors
# residents
# nurses
Coronary Unit
12
526
2992
5.70
68.30%
2.3
6.8
Dermatology
8
181
1221
6.70
41.80%
1
6
Gynecology
27
1056
4441
4.20
45.10%
6.1
15.3
Infectious Diseases
25
500
2304
4.60
25.20%
2
8
Intensive Care
4
200
551
2.80
37.70%
3
11.3
Internal Diseases
48
1663
14626
8.80
83.50%
8.5
16.8
Maternity
0
0
0
0.00
0.00%
0
16
Neonatology
33
2123
7134
3.40
59.50%
2
15
Neurology
24
695
6999
10.10
79.90%
3
13.5
Obstetrics
33
2492
10453
4.20
86.80%
6.1
14.8
Ophthalmology
15
240
1509
6.30
26.80%
2.3
6
ORL
12
237
1373
5.80
32.00%
3
5
Report 2: Data ______________________________________________________________________________________ 45
____________________________________________________________________________ Kosovo Health Master Plan
Table 20 (continued): Gjakova Regional Hospital
GJAKOVA
# Beds
Discharges
Bed days
ALOS
ABO
# doctors
# residents
# nurses
Orthopedic
17
464
3436
7.40
55.40%
3
10.8
Pediatrics
49
1628
7826
4.80
43.50%
8
24.1
Psychiatry
26
383
7092
18.50
74.70%
2
9
Surgery
44
1581
6533
4.10
40.40%
5.6
16.5
Thorax
24
781
7453
9.50
85.10%
3
7
Urology
14
525
2569
4.90
50.30%
3
8.7
TOTAL
415
15275
88512
5.79
58.43%
63.9
210.6
Table21 : Gjilan Regional Hospital
GJILAN
# Beds
Discharges
Bed days
ALOS
ABO
# doctors
# residents
Coronary Unit
13
467
2855
6.10
60.20%
2
11
Dermatology
0
0
0
0.00
0.00%
0
0
Gynecology
47
1236
9091
7.40
53.00%
12
38
Infectious Diseases
32
931
5154
5.60
45.00%
7
10
Intensive Care
17
2006
1599
0.80
25.80%
17
13
Internal Diseases
57
1508
16219
10.80
78.00%
15.2
18
Maternity
8
0
0
0.00
0.00%
0
0
Neonatology
29
2365
4119
1.70
38.90%
8.2
12.3
Neurology
0
0
0
0.00
0.00%
0
0
Obstetrics
43
2494
6199
2.50
39.50%
0
0
Ophthalmology
0
0
0
0.00
0.00%
0
0
ORL
21
708
4838
6.50
63.10%
8
7
Orthopedic
18
389
2878
7.40
43.80%
5
7
Pediatrics
32
1095
5424
5.00
46.00%
7.4
14.8
Psychiatry
11
62
3136
50.60
78.10%
4.6
11
Surgery
27
1128
6224
5.50
63.20%
9.8
12
Thorax
32
453
8126
17.90
69.60%
5.3
9
Urology
15
538
3489
6.50
63.70%
4
7
TOTAL
402
15380
79351
5.16
54.08%
100
Bed days
2799
ALOS
5.20
ABO
63.90%
17
# nurses
313
Table 22: Peje Regional Hospital
PEJA
Coronary Unit
# Beds
12
Discharges
536
# doctors
3
# residents
# nurses
20.8
Report 2: Data ______________________________________________________________________________________ 46
____________________________________________________________________________ Kosovo Health Master Plan
Table 22 (continued): Peje Regional Hospital
PEJA
Dermatology
Gynecology
Infectious Diseases
Intensive Care
Internal Diseases
Maternity
Neonatology
Neurology
Obstetrics
Ophthalmology
ORL
Orthopedic
Pediatrics
Psychiatry
Surgery
Thorax
Urology
TOTAL
# Beds
8
31
24
7
46
0
41
14
33
11
18
33
28
18
40
64
20
448
Discharges
137
1455
697
401
1044
0
2715
538
2784
160
218
907
1022
226
1652
737
788
16017
Bed days
1893
8488
5873
1086
11285
0
5340
3340
6454
2502
1488
8858
4296
3870
8002
16354
6087
98015
ALOS
13.80
5.80
8.40
2.70
10.80
0.00
2.00
6.20
2.30
15.60
6.80
9.80
4.20
17.10
4.80
22.20
7.70
6.12
ABO
64.83%
75.02%
67.04%
42.50%
67.21%
0.00%
35.68%
65.36%
53.58%
62.32%
22.65%
73.54%
42.04%
58.90%
54.81%
70.01%
83.38%
59.94%
# doctors
2
6
3
0.5
8
0
3
3.4
6
3
3.3
4
6
4
7.5
10
4
105
# residents
4
# nurses
2
8.2
12
9.1
15
0
12.6
10.3
16.8
4
4.3
10.6
12.3
6.1
13.3
15
7.5
299
Table 23: Prizren Regional Hospital
PRIZREN
# Beds
Discharges
Bed days
ALOS
ABO
# doctors
Coronary Unit
10
306
1492
4.90
40.90%
2
10.3
Dermatology
7
22
472
21.50
17.60%
1.4
4.2
Gynecology
Infectious
Diseases
30
1774
6852
3.90
62.60%
4
9.8
30
1165
5843
5.00
53.40%
2.3
12.3
8
886
1794
2.00
61.40%
11
12.4
70
2475
18146
7.30
71.00%
13.1
18.1
0
0
0
0.00
0.00%
1
14.3
Neonatology
28
4332
7882
1.80
77.10%
7
15.9
Neurology
25
821
6160
7.50
67.50%
4
16
Obstetrics
66
4995
13608
2.70
56.50%
15
14
Ophthalmology
25
618
4452
7.20
48.80%
7.3
11
ORL
31
1199
6445
5.40
57.00%
7.9
14.2
Orthopedic
27
908
5909
6.50
60.00%
6.5
11.6
Pediatrics
70
2282
12738
5.60
49.90%
12
25.8
Psychiatry
26
435
2901
6.70
30.60%
3
15
Surgery
55
3228
12809
4.00
63.80%
15
14.8
Intensive Care
Internal Diseases
Maternity
# residents
# nurses
Report 2: Data ______________________________________________________________________________________ 47
____________________________________________________________________________ Kosovo Health Master Plan
Table 23: Prizren Regional Hospital
PRIZREN
# Beds
Discharges
Bed days
ALOS
ABO
# doctors
# residents
# nurses
Thorax
45
486
9367
19.30
57.00%
8
13.7
Urology
24
636
3865
6.10
44.10%
5
8.6
TOTAL
578
26568
120735
4.53
64.73%
125.5
242
# Beds
Discharges
Bed days
ALOS
ABO
# doctors
11
595
2399
1.65
59.80%
2
5
6
581
1252
1.61
57.20%
3.3
9
12
238
2426
0.66
60.40%
2
8
Maternity
4
976
0
2.94
0.00%
1.3
4
Obstetrics
12
155
2326
2.30
53.10%
1
8
Pediatrics
17
411
2161
1.14
34.80%
3
7
Surgery
15
1005
3855
2.79
69.30%
7
24
TOTAL
78
3961
14419
3.64
54.70%
19.6
65
Table 24: Vushtrri Hospital
VUSHTRRI
Gynecology
Intensive Care
Internal Diseases
# residents
# nurses
Table 25: All regional hospitals
Regional Hospital
Ferizaj
Gjakova
Gjilan
Mitrovice
Peje
Prizren
Vushtrri
TOTAL
# Beds
64
Discharges
4038
Bed days
7306
ALOS
1.81
ABO
31.28%
# doctors
30
# residents
# nurses
137
415
15275
88512
5.79
58.43%
63.9
402
15380
79351
5.16
54.08%
100
0
0
0
448
16017
98015
6.12
59.94%
105
578
26568
120735
4.53
64.73%
125.5
242
78
3961
14419
3.64
54.70%
19.6
65
1,985
81,239
408,338
5.0
56%
482
210.6
17
38
313
177
4
21
299
1,444
Report 2: Data ______________________________________________________________________________________ 48
____________________________________________________________________________ Kosovo Health Master Plan
Table 26: Prishtina University Clinical Center by Department
Department name
MEDICAL
Cardiology 1
Cardiology 2
CCU
Dermatovenerology
Endocrinology
Gastroenterology
Hematology
Infectious Diseases
Nephrology
Neurology
Pediatrics
Pulmology
Rheumatology
Psychiatry - general & ICU
Psychiatry - ICU
SURGICAL
Abdominal Surgery A
Abdominal Surgery B
Abdominal Surgery C
Abdominal Surgery HB
Maxillofacial
Neurosurgery
Ophthalmology
ORL
Orthopedic Surgery
Pediatric Surgery
Plastic Surgery
Thoracic Surgery
Urological Surgery
Vascular Surgery
OBS and GYN
Delivery Rooms
Gynecology incl neonatal
Neonatal ICU
TOTAL
# Beds
Discharges
Bed days
ALOS
ABO
# docs
# res
# nurses
18
18
13
40
38
38
27
109
26
87
240
77
26
95
14
888
924
888
681
720
1260
480
1683
480
3633
4980
1481
456
939
194
7851
5414
4356
9231
9764
11776
7716
30456
6415
24807
50679
23052
7526
20676
3225
8.61
7.05
5.04
13.68
14.03
9.09
16.08
18.23
11.88
7.90
10.60
15.76
15.68
18.50
18.1
119.50%
82.40%
91.80%
57.50%
70.40%
84.90%
78.30%
76.55%
67.60%
74.00%
57.85%
86.70%
79.30%
59.63%
74.00%
6
10
5
18
5
7
4
10
8
14
38
12
4
11
2
4
1
6
9
14
17
26
13
17
16
60
13
61
130
31
11
46
18
20
20
20
20
40
44
54
73
106
38
22
36
40
38
504
900
720
612
531
1104
1788
3018
1692
1683
696
744
690
744
4168
5395
6300
5358
5442
11817
11685
22458
24177
8946
6440
13850
4500
11984
8.08
5.69
9.55
9.92
9.70
10.37
6.30
9.60
15.30
6.90
8.01
24.04
12.10
18.49
57.10%
73.90%
86.30%
73.40%
37.27%
92.60%
59.28%
85.00%
62.49%
63.20%
80.20%
105.40%
49.60%
86.40%
7
8
6
8
6
8
19
16
37
7
6
6
10
9
11
369
100
1,917
43617
10038
89,038
119796
28824
514,084
2.60
2.80
87.30%
77.50%
43
11
361
2
6
6
8
13
12
2
15
2
4
2
3
3
10
5
4
10
3
4
4
1
27
179
12
13
12
12
14
25
62
59
91
20
13
22
22
19
204
50
1,132
Report 2: Data ______________________________________________________________________________________ 49
____________________________________________________________________________ Kosovo Health Master Plan
Table 27: Laboratory and XRay services in Hospitals
Department name
Infectious Diseases
Neurology
Psychiatry - general & ICU
Psychiatry - ICU
Ophthalmology
ORL
Gynecology incl neonatal
Total
Number lab
tests/year
31242
5653
8217
2982
22919
3626
169812
804,000
Number XRay test/year
940
\
\
\
120
72,000
HEALTH INFORMATION SYSTEM
There have been several attempts over the years to introduce a health
information system and to gather data necessary for health planning, with
varying degrees of success. During the site visits to a number of the main family
health centers, examination was made of the systems and the process undertaken
by the staff to enter the data.
The nature of the system and the fact that the data is initially entered on paper by
administration and clinical staff and then entered into the HIS by data entry
clerks, raises the possibility of significant coding and other data entry errors. It
was also mentioned in a number of facilities that they had stopped entering data
some time ago due to some technical problem. The personnel also raised the
issue that they did not receive any feedback about all the data they provided to
the NIPH.
It is clear that the current health information system is not adequate for the
needs of facilities.
There has been a strategic plan for health information prepared by a committee
with representation from both NIPH and MSH and the plan has recently been
reviewed. Work should continue to progress this plan.
Report 2: Data ______________________________________________________________________________________ 50
____________________________________________________________________________ Kosovo Health Master Plan
7.
FINDINGS - RESOURCES
BUDGETING
Funding for health at the primary care level comes from three basic sources
shown in Table 28. Staff salaries are paid directly from the Ministry of Economy
and Finance (MEF) and 40% of the Goods & Services (G&S) part of the central
health care budget is diverted to the MSH for EDL drugs supply; an MEF grant
based on population estimates is provided to municipalities for supporting their
primary health care facilities; and ‘self generated revenue’ ie money derived from
copayments for services by the few groups which are not exempt. Some
municipalities also provide an additional grant for further support of PHC
services or of specific patients (eg with cancer).
The figures below were provided by municipality H&SW areas and some
inconsistencies are apparent.
Table 28: Funding for Primary Health Care
MEF grant
total
307835
Salaries
component
287254
G&S
component
37581
Utilities
component
25000
Copayments
revenue
30000
Municipal
health
grant
42000
Total PHC
budget
(1)
Dragash
315053
231220
65833
18000
38562
2630
671298
Ferizaj
1152440
800222
279649
36896
117405
10000
1279845
Fushe Kosove
281753
108000
23841
10000
8000
Gjakova
925667
84000
100000
40326
40000
40326
Gjilan
Gllogoc
1133700
483005
665370
442263
85140
127414
35000
37479
248000
69200
48000
82260
Municipality
Decan
Hani I Elezit
Istog
Junik
Kacanik
41000
354204
94778
346825
289753
0
56393
260648
31885
86177
6500
326754
598493
93609
138394
33482
77679
25000
22439
17985
31000
80000
33000
38359
55000
5000
19788
Kamenice
Kline
Lipjan
Malisheve
Mamushe
Mitrovice N
495148
458725
379835
1005993
1429700
634465
41000
354204
94778
457825
0
533148
712561
513725
0
0
Report 2: Data ______________________________________________________________________________________ 51
____________________________________________________________________________ Kosovo Health Master Plan
Table 28 (continued): Funding for Primary Health Care
Municipality
Mitrovice S
Novoberde
MEF grant
total
866770
43250
Salaries
component
662552
Goods &
services
component
138218
Utilities
component
66000
Obiliq
Copayments
revenue
43544
438
Municipal
health
grant
Total PHC
budget
(1)
910314
43688
17000
17000
Peje
1240000
920000
65000
80000
45000
Podujeve
973757
577195
265665
39000
8971
Prishtina
3220036
2097619
742400
291046
102000
Prizren
1730000
1171000
457000
75000
210000
20400
1960400
Rahovec
512156
281103
186180
44873
45878
3000
561034
Shterpce
88000
66000
14000
7000
1000
0
89000
Shtime
225403
167003
38600
11800
25000
25000
275403
648131
126871
35315
20197
340541
215385
30000
40000
129924
22359
106647
35400
Skenderaj
Suhareke
720000
Viti
Vushtrri
603757
461710
1285000
26503
3322036
830514
25000
785000
152283
50000
653757
Zubin Potoc
0
Zvecan
+Sums where
no MEF total
Sub Total
+40% total
G&S
1009231
0
1691103
16257209
10904817
3486551
974939
1248354
347637
2324367
20104727
10904817
2324367
5810918
974939
1248354
429907
19658235
2324367
21700728
% PHC
92.6
61.6
32.8
5.5
5.8
1.6
budget
Note: 1. Total budget = MEF grant + copayment revenue + municipal health grant
2. MEF deducts 40% G&S budget and provides directly to MSH for the supply of EDL drugs
3. The %PHC budget is calculated as: % income for MEF grant, SGR and municipal grant; and as %
spending for 3 items for salaries, G&S and utilities
PROCUREMENT
A number of municipalities raised issues about the procurement process. They
indicated that the processes are too complex and take too long, including for low
value items. An example given was the procurement process required to service
Report 2: Data ______________________________________________________________________________________ 52
____________________________________________________________________________ Kosovo Health Master Plan
the various emergency vehicles. The process effectively prevented them from
attracting a suitable supplier, resulting in the many unserviced vehicles lying idle,
while the need for emergency vehicles is high.
A number of municipalities also indicated that, given the consistent failure to
provide them with drugs from the Essential Drug List, they would like the
opportunity to procure the required drugs themselves, such as insulin. A number
of municipalities do this currently from extra municipal funds but find difficulties
again eg with the procurement law that requires one contract to be finished
before another contract be entered into, even if the original contractor is unable
to fulfill the contract (for example by drugs being out of stock).
Specific issues mentioned during the interviews also included the lack of auditing
and monitoring in the procurement process, too much focus on low price, and the
complexity of the process even for low value items. QKMF and Municipality
Health Services Directors also believe that the municipal administrators do not
understand the urgency of some of the health procurement needs.
HOSPITAL DEPARTMENT STRUCTURE
The regional hospital department structure is consistent throughout Kosovo,
with the following departments:
Coronary Unit
Dermatology
Infectious Diseases
Intensive Care
Internal Diseases
Neonatology
Neurology
Pediatrics
Psychiatry
Thorax
Obstetrics
Maternity
Gynecology
Ophthalmology
ORL
Orthopedics
Surgery
Urology
Report 2: Data ______________________________________________________________________________________ 53
____________________________________________________________________________ Kosovo Health Master Plan
Prishtina University Clinical Center reports to a similar structure, however site
visits suggest that the following is the actual functional separation of the clinical
specialties there:
Coronary Unit
Cardiology 1
Cardiology 2
Dermatovenerology
Endocrinology
Gastroenterology
Hematology
Infectious Diseases
Nephrology
Neurology
Pediatrics
Psychiatry - general & ICU
Psychiatry – ICU
Pulmology
Rheumatology
Abdominal Surgery A
Abdominal Surgery B
Abdominal Surgery C
Abdominal Surgery HB
Maternity Delivery Rooms
Gynecology including neonatal
Maxillofacial
Neonatal ICU
Neurosurgery
Ophthalmology
ORL
Orthopedic Surgery
Pediatric Surgery
Plastic Surgery
Thoracic Surgery
Urological Surgery
Vascular Surgery
HOSPITAL BEDS AND STAFFING
A number of health resource parameters are relatively low in Kosovo compared
to other countries. Comparator countries for considering parameters have been
discussed with the Health Services Working Group and those agreed to be
potentially interesting were:

Albania, TFYR Macedonia – neighbor countries and a destination for some
health care

Belgium, Ireland – geographically small, developed countries

Croatia, Slovenia – ex-Yugoslavia, reforming health systems

Italy, Germany – destination for some health care

Denmark, Finland, UK – source of major health care reform projects in
Kosovo

Sweden – more socialist/welfare model

Group of older EU countries

Group of newer EU countries.
Report 2: Data ______________________________________________________________________________________ 54
____________________________________________________________________________ Kosovo Health Master Plan
Again care is needed in making comparisons as indicated previously. The full
range of considerations will be taken into account when selecting parameters
for designing Kosovo’s health network.
This will be discussed in more detail within the Expert Working Group on
Planning but include:

The number of acute care hospitals in Kosovo is approximately
0.5/100,000 people
Figure 1: Comparing the number of acute care hospitals in Kosovo
Kosovo

The number of acute care beds in Kosovo is 180/100,000
Figure 2: Comparing the number of acute care beds in Kosovo
Kosovo

The number of psychiatric beds in Kosovo is 8.6/100,000
Report 2: Data ______________________________________________________________________________________ 55
____________________________________________________________________________ Kosovo Health Master Plan
Figure 3: Comparing the number of psychiatric beds in Kosovo
Kosovo

The number of specialist physicians in Kosovo is 45/100,000.
Figure 4: Comparing the number of specialist physicians in Kosovo
Kosovo
HOSPITAL AVERAGE BED OCCUPANCY
Bed occupancy measures the percentage of time a bed has a patient in it. This is
not recommended to be 100% as time is needed to change from one patient to
another, and there should also be the ability to cope with seasonal variation. In
the Regional Hospitals the bed occupancy for the various departments is in Table
29. In the Prishtina University Center the Average Occupancy Rate tends to be
higher (Table 29).
Report 2: Data ______________________________________________________________________________________ 56
____________________________________________________________________________ Kosovo Health Master Plan
Table 29: Average bed occupancy rates in QKUK and range of bed occupancy in regional
hospitals
Department
Abdominal Surgery
Coronary Care
Cardiology
Endocrinology
Gastroenterology
Gynecology
Intensive Care
Internal Medicine
Maxillofacial
Neonatology
Neonatal ICU
Nephrology
Neurology
Neurosurgery
Neurology
Obstetrics
Ophthalmology
ORL
Orthopedics
Orthopedic Surgery
Pediatric Surgery
Pediatrics
Plastic Surgery
Psychiatry
Psychiatric ICU
Surgery
Thorax / Pulmology
Thoracic Surgery
Urological Surgery
Vascular Surgery
Bed Occupancy QKUK
70.2%
91.8%
100%
70.4%
84.9%
87.3%
Regional Hospital Bed
Occupancy Range
40%-68.3%
31.4% - 71.5%
25.8% - 61.4%
40.2% - 83.5%
37.7%
35.7% - 77.1%
77.5%
67.6%
74%
92.6%
74.0%
97.3%
59.3%
85%
62.5%
63.2%
57.9%
80.2%
59.6%
74%
86.7%
105%
49.6%
86.4%
65.4% - 79.9%
39.5% - 86.8%
26.8% - 62.3%
22.6% - 63.0%
43.8% - 73.5%
29.3% - 49.9%
30.6% - 78.1%
25.9% - 69.3%
57.0% - 85.1%
It is clear that day surgery is not a concept that has been adopted to any degree in
Kosovo, with the vast majority of cases being more than one day. No separate day
surgery units were in evidence, though of course some procedures were admitted
and discharged on the same day. Some facilities put training in endoscopic
surgery techniques as one of their priorities in order to reduce the necessary
length of hospital stay.
Report 2: Data ______________________________________________________________________________________ 57
____________________________________________________________________________ Kosovo Health Master Plan
PRIMARY HEALTH CARE STAFF
Through this project we have identified 436 Primary Care facilities, 31 being
classified as Main Family Health Centers (QKMF), 154 Family Health Centers
(QMF), 251 Punkts (AMF). Of these we have identified to date 61 facilities catering
mainly or exclusively for the Serbian population.
The Integrated Mental Health Centre, 8 Community Mental Health facilities and 8
Integrated Mental Health Houses are funded separately through a line item in the
MSH budget and staff numbers in primary care in municipalities do not include
these facilities.
In comparison to other countries primary care in Kosovo is low in regards to a
number of parameters. These will be discussed in more detail in the Expert
Working Groups:

The number of primary health care facilities in Kosovo is 20.3/100,000
population
Figure5. The number of primary health care facilities in Kosovo
Kosovo

The number of primary care physicians in Kosovo is 47/100,000
Report 2: Data ______________________________________________________________________________________ 58
____________________________________________________________________________ Kosovo Health Master Plan
Figure 6. The number of primary care physicians in Kosovo
Kosovo

The number of primary care nurses in Kosovo is 138/100,000; the
number of nurses overall is 260/100,000.
Figure 7. The number of nurses in Kosovo
Kosovo
Pending further investigation, it should be noted that a number of features of the
Kosovo health systems mandate caution in making comparisons with other
countries:

Primary health care facilities are mainly either very large QKMFs or very
small AMFs while PHC facilities in many comparison countries are of small
to medium size and more uniform. Thus access times (with waiting times
policies) may be more relevant measures of adequacy of the PHC network.

Most physicians and some nurses work double shifts – one in the public
sector and one in the private sector – effectively substantially increasing
the total number of physicians available.
Report 2: Data ______________________________________________________________________________________ 59
____________________________________________________________________________ Kosovo Health Master Plan
The following tables show the total number of doctors, nurses and dentists in
primary health care for each municipality. The technical, administrative and
support staff are listed separately in the municipality summaries. Note that in the
following table, as indicated previously Serbian health professionals may (eg in
Fushe Kosovo) or may not (eg in Novoberde, Shterpce) be included in municipality
estimates. Doctors and specialist doctors (except family medicine specialists included in ‘doctors'); dentists, and specialist dentists; are both counted
separately. Resident doctors are also counted separately, as they are available
part time. Because sometimes they are the doctor listed as working 2 days a week
in the punkts, the total count of doctors may be an overestimate in some
municipalities.
Table 30: Summary of doctors, nurses and dentists in municipalities
Municipality
Total PHC
employees
Doctors
Specialists
Residents
Dentists
Decan
121
25
10
2
5
Dragash
98
9
5
4
Ferizaj
308
31
7
18
Fushe Kosove
103
24
3
8
Gjakova
351
69
4
8
Gjilan
320
56
Gllogoc
185
33
Dental
specialists
Nurses
Doctor/
100000
Nurse/
100000
82
86.6
203.0
1
35
34.3
100
3
119
34.2
107.2
2
43
103.9
127.7
32
263
70.4
228.7
27
160
55.8
159.4
111
55
185
0
0
10
40
100
9
67
59.1
152.3
2
Gracanica
Hani I Elezit
18
4
Istog
126
20
6
Junik
22
2
1
1
10
41.7
104.2
Kacanik
105
24
1
4
65
87.8
197
Kamenice
180
13
6
1
78
40.3
157.3
Kline
138
16
8
1
78
56.8
177.3
0
0
147
60.8
212.7
53
32.7
101.9
5
16.7
83.33
0
0
149
35.6
165.6
4
40
160
56
69.2
215.4
1
Leposavic
Lipjan
270
38
4
Malisheve
122
15
2
Mamushe
8
1
2
1
4
Mitrovice Nth
Mitrovice
32
Novoberde
1
Obiliq
99
18
9
4
Report 2: Data ______________________________________________________________________________________ 60
____________________________________________________________________________ Kosovo Health Master Plan
Table 30 (continued): Summary of doctors, nurses and dentists in municipalities
Municipality
Total PHC
employees
Doctors
Specialists
Peje
318
44
Podujeve
246
Prishtina
862
Prizren
Dentists
Dental
specialists
Nurses
Doctor/
100000
Nurse/
100000
12
16
9
159
48.7
138.3
49
19
4
124
58.1
106
194
32
23
18
367
58.2
94.45
26
12
274
28.4
127.5
68
39.7
107.9
26.0
0
40
82.1
142.9
102
42.9
182.1
107
35
133.8
Residents
61
Rahovec
129
25
Shterpce
16 (A) 330(S)
1
Shtime
19
4
2
Skenderaj
176
22
2
Suhareke
151
25
3
Viti
55
19
3
2
2
92
51.7
198
23
9
2
5
82
45.3
109.3
Zubin Potoc
0
0
Zvecan
0
0
48.55
132.7
Vushtrri
Totals
4408
913
7
141
29
1
201
48
2950
NUMBERS AND TYPES OF UNEMPLOYED HEALTH WORKERS
Each municipality was asked about the number and type of unemployed health
workers in the municipality. This was to try to understand the impact on human
resources of increasing or decreasing levels of employees.
Table 31: Estimated unemployed health workers in municipalities
Municipality
All PHC sector employees
Unemployed health workers
Decan
121
100 nurses, 1 orthopedist, 1 GP
Dragash
98
Ferizaj
308
100 Nurses
3 FM specialists,, 6 dental specialists, 1
Pediatrician, 5 GPs
Fushe Kosove
103 (85 A; 18 min)
FM, GP, dentist
Gjakova
351
15 GPs, dentist, vascular surgeon, plastic
surgeon
Gjilan
320
12 GPs, internal medicine, orthopedist
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Table 31 (continued): Estimated unemployed health workers in municipalities
Municipality
Gllogoc
All PHC sector employees
Unemployed health workers
185
55
Hani I Elezit
18
Nurses
Istog
126
Junik
22
15 nurses
Kacanik
Kamenice
Kline
105
180
138
1 midwife
Gracanica
2 GP, 1 gynecologist
Leposavic
Lipjan
270
Nurses
Malisheve
122
100 nurses
Mamushe
8
Mitrovice Nth
none
Mitrovice
Novoberde
none
Obiliq
99
20 nurses
Peje
318
30 docs
Podujeve (Besiane)
246
100 nurses/3 GP/1 Pediatrician
Prishtina
862
at least 20 doctors
Prizren
3 doctors
Rahovec
129
Shterpce
16 (A) 330(S)
Shtime
0
Many nurses unemployed
Skenderaj
176
200 nurses
Suhareke
151
100 nurses, 1 physiotherapist,1 psych
Viti
55
Vushtrri
Zubin Potoc
20 GPs
Zvecan
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PHARMACEUTICALS
Pharmaceuticals supply was the most frequently mentioned important issue to
resolve in the health system for all municipalities. The current arrangement is for
the MSH to procure and distribute all the necessary drugs from the essentials drug
list (EDL). The logic in taking this taking this approach is obvious in regards to the
potential to negotiate better prices. It is clear however that this process is not
operating well at the present time.
With the possible exception of the Prishtina City Emergency Center, where the
patient load is small, and the range of drugs required is less, every other facility, in
all levels of care, report a massive lack of EDL drugs compared to what they need
each month. The facilities consistently reported that they only receive 15-30% of
the requested drugs each month. Results of examinations of records in 11 PHC
facilities are in Table 32. Facilities also report issues with the drugs being close to
their expiry date and sometimes receiving drugs which had not been ordered.
PHC facility pharmacies had an average of 20 of the 94 of the drugs on the EDL
which could be expected to be on their shelves at the time of visit.
Table 32: EDL drugs requested and supplied to primary health care facilities
Request provided to
MSH
Received from
MSH
% order
received
QKMF
Month
Skenderaj
December 2007
74882
16437
22
Vushtrri
January 2008
54992
15005
27.3
Kline
March 2008
33860
2660
7.9
Junik
April 2008
5135
1521
29.6
Podujeve
April 2008
39047
21230
54.4
Drenas
April 2008
45248
23332
51.6
April 2008
86750
7556
8.7
Dragash
April 2008
48935
11928
24.4
Gjilan
May 2008
49070
25705
52.4
Malisheve
May 2008
45208
8901
19.7
Suhareke
May 2008
15262
4240
27.8
Total
498389
138515
27.8%
An inspection for a basket of 14 emergency drugs – adrenaline, atropine,
penicillin, chlorpromazine, dexamethasone, diazepam, digoxin, frusemide, glyceryl
trinitrate, lignocaine (or similar), metoclopramide, morphine (or similar),
salbutamol, verapamil - was made during the site visits. The inspection was to see,
on the particular day of the inspection, how many of the 14 drugs were present in
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the emergency department, or even in the facility. On average in primary care
facilities there were 6.8 of the 14 drugs, or 49%. In the case of the City Emergency
Center 13 of the 14 drugs were present, or 93%.
Table 33: Emergency drugs availability
Emergency Drug
% facilities having
Adrenaline
91%
Diazepam
78%
Dexamethasone
70%
Frusemide
70%
Metoclopramide
70%
Atropine
48%
Penicillin
48%
Verapamil
48%
Morphine (or similar analgesic)
43%
Chlorpromazine
39%
Digoxin
35%
Lignocaine (or similar local anaesthetic)
30%
Salbutamol
26%
Glyceryl trinitrate
22%
Another pharmaceuticals related concern is that presently in all levels of care
(including the MSH) there are only a couple of pharmacists. When planning our
reviews of pharmacy departments, we had an assessment which covered the
range of processes, materials and services which would be expected in a health
facility pharmacy. It became apparent that the only processes in the pharmacies
visited were inventory control and basic dispensing logs; the only materials were
drugs and some supplies; and there were no pharmaceutical management services
available. As drugs become more available this will be of increasing concern.
Already there are signs of poor medicine use, such as the wide reliance on
injectables and infusions. As drugs become more readily available, medication use
problems will also increase. Staff interviewed believed that patients were well
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informed about their condition – a belief that usually indicates a lack of awareness
of the problems patients have managing their conditions.
The overabundance of nurses for their present patient load offers the opportunity
for patient education programs, and this has commenced in some facilities. In the
current absence of pharmacists, training for nurses in wise use of medicines and
communicating with patients about their medication management, would be a
sensible investment at this stage.
EQUIPMENT
GENERAL
Equipment - right from the most basic - is generally lacking in all levels of care. As
part of the examination of primary care facilities, the staff was asked to confirm
the presence of any of the following items that were identified in MSH
administrative decisions as mandatory for primary care in specific circumstances.
There are clearly shortages in terms of many items of primary care equipment.
The results are in Table 34.
Table 34: Percent of primary health care facilities having any working item
Equipment
% having item
Equipment
% having item
Stethoscope
100%
Growth chart
18%
Sphygmomanometer
82%
Ob/Gyn set
18%
Sterilizer
82%
Ear syringe
18%
Ophthalmoscope
73%
Antishock therapy
18%
Otoscope
73%
Oxygen
18%
Refrigerator
73%
Infusion set
18%
Gloves
73%
Torch
9%
ECG
64%
Height board for babies
9%
Adult scales
55%
Tourniquet
9%
Baby scales
55%
Ophthalmological set
9%
Microscope
55%
Snellen eye chart
9%
Fetoscope
45%
Urine dipstick
9%
Defibrillator
45%
Life support kit
9%
Centrifuge
45%
Autoclave
9%
Photometer
45%
Temporary splints
9%
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Table 34: Percent of primary health care facilities having any working item
Equipment
% having item
Equipment
% having item
Reflex Hammer
36%
Doctor’s bag equipped
9%
Nebulizer
36%
Laryngoscope
9%
Generator
36%
9%
Glucometer
Peak Flow Meter
Tongue depressors
Doppler
Thermometer
27%
27%
27%
18%
18%
Bandages
Development assessment
toys
Glucose test strips
Fluoroscein eye strips
ET tube
Nasal speculum
Tape measure
18%
0%
0%
0%
0%
0%
Some facilities also provided the quantity of these items. Of those items, Table 35
selects items which are basic to the practice of a primary care physician. When the
number of doctors in the relevant facilities is taken into account, it can be seen
that the basic equipment lack is even more concerning.
Table 35: Average number of working pieces of equipment per doctor
Item
Tongue depressors
per doctor
2.7
Item
Glucose test strips
per doctor
0.2
Disposable Gloves
2.7
Ophthalmological set
0. 1
Stethoscope
1.1
Ophthalmoscope
0.1
Sphygmomanometer
1.1
Otoscope
0.1
Sterile bandages
Antishock therapy (adrenaline)
0.7
Torch with battery
0.1
0.4
Growth charts
0.1
Peak flow meters
0. 2
Doctor bags with equipment
0.1
Reflex hammer
0.2
Snellen eye charts
0
Thermometer
0.2
Urine dipsticks
0
Tape measure
0.2
Small surgical kits
0
Weighing scales (adults)
0.2
Similarly in secondary and tertiary care facilities, there appears to be a general
lack of essential equipment. Staff in every department cited items essential to
their work which were not available, too old, or not maintained adequately
enough to be relied upon.
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LABORATORY EQUIPMENT AND XRAYS
Each QKMF and many QMFs have basic laboratory equipment. The most
commonly seen equipment is:
Hematology Analysers:
Medonic CA620
Sysmex KX21N
Photometers: Clinical Chemistry Analyzers:
Dialab DTN 410
Humalyzer 2000
Humalyzer Junior.
The majority of equipment has been donated and there are many examples of
broken equipment or new equipment that has never been used because of lack of
specific reagents, or more frequently because of the price of the reagent or lack of
maintenance and servicing budget.
The typical equipment seen in primary care is designed as relatively low volume
equipment. Some of the QKMFs are located close to regional hospitals, which also
may have relatively low volume equipment.
A similar situation is taking place in radiology where the choice of which XRay
equipment to place in what situation appears somewhat haphazard. Some
primary care facilities receive relatively sophisticated equipment even in one case
a CT scanner, while the hospitals, where it would be expected that larger more
comprehensive equipment is needed, receive potentially inadequate equipment.
Maintenance of imaging equipment is also a problem with many examples of
malfunctioning equipment lying around radiology departments.
The Master Plan will outline a strategy whereby services are consolidated where
possible, thereby enabling the purchase of larger volume equipment with lower
overall cost, as well as a strategy to ensure appropriate maintenance of
equipment.
EMERGENCY VEHICLES
Emergency services vehicles are organized through the primary care system and
are usually located at the main family health care center. It is routine practice for
the doctor to take with them the emergency pack including drugs and
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resuscitation equipment etc, so the vehicles themselves don’t routinely contain
these items. They should however contain oxygen and be suitably designed for
emergency work.
The ambulances and other cars based in hospitals are used to transfer cases to
tertiary care in Prishtine. Some hospitals also transport dialysis patients for the
municipality in which they are located. (Otherwise this is a task for the QKFM
vehicles.)
The site visits indicated that the lack of suitable vehicles was probably the second
issue of concern, mentioned after the EDL drug supply problem. Inspections were
made of quite a number of vehicles and most were donated, dated back quite a few
years, and were in poor condition. See Table 36.
One of the better supplied is the Prishtina City Emergency Center that provides
emergency services for the Prishtina region. They have 2 donated ambulances that
are in good condition, 2 in poor condition and 2 cars. This is clearly inadequate for
a population of 400,000 - 500,000 people.
A strategy will be developed as part of the Master Plan to address this issue.
Table 36: Auto ambulances
Total
vehicles
Functional
& equipped
Gjakova Hospital
4
3
Average condition. 1 is only suitable for simple cases.
Mitrovica Sth Hospital
2
2
.Both fully equipped, 1 is being serviced
Prizren Hospital
4
Peje Hospital
5
5
Decan QKMF
1
0
Dragash QKMF
3
3
1 ambulance is in Bresiane; have additional car in very
bad condition to take dialysis patients to Prizren
Ferizaj QKMF
4
1
3 are not equipped
Fushe Kosove QKMF
2
1
Gjakova QKMF
4
3
3 are right hand drive, 2 are equipped well, 3 are new.
Gjilan QKMF
2
Gllogovc QKMF
3
1
Old not equipped; 60 transported to Prishtine/month
2 other vehicles are used to transport dialysis patients
(no air conditioning - 100Km/day)
Hani I Elezit QKMF
2
1
Facility
Notes about auto ambulances
All are 15 yrs old, in poor condition, with no equipment
All old. 1 vehicle equipped for resuscitation. Plus 6 not
used due to lack of documents or unpaid registration
Have a minibus for dialysis transport
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Table 36: Auto ambulances
Total
vehicles
Functional
& equipped
Junik FMC
1
0
Kamenica QKMF
5
2
Kline QKMF
9
2
Lipjan QKMF
3
1
Malisheve QKMF
9
3
Mamushe QKMF
1
1
Mitrovica QKMF
4
3
Not adequately equipped. Donated, so different
models and cannot get servicing of all vehicles
Novoberde QKMF
3
2
1 is in Prekovc, but only one driver who is in
Novoberde.
Obliq-Katriot QKMF
1
0
Podujeve QKMF
8
3
Rahovec QKMF
4
4
Shterpce QKMF (KS)
6
6
Shterpce QMF (KA)
1
0
Suha Reke QKMF
4
4
Shtime QKMF
3
1
Facility
Notes about auto ambulances
1 vaccination car, 1 dialysis car
1 is an autoambulance; 1 is a minibus for dialysis, 1 is
not functioning
Transfer cancer cases to Tirana – only can take
maximum 5 a month; only 1 ambulance is not too old
3 are ambulances; 1 car is for vaccination; 4 are for
dialysis patient transport
All are very old. Most urgent need is new minibus for
dialysis transport. Don't do home visits due to lack of
transport.
2 are used to transport patients to Beograd. All
vehicles are 19 yrs old.
Have 1 Lada car. No emergency vehicle.
Very old, difficult to maintain, and heavy fuel
consumption
Skenderaj
4
1
Viti QKMF
1
0
Other 3 in bad condition - all donated 6 yrs ago. Repair
expenses too high. Have another 2 cars for dialysis
patient transport
Minibus for dialysis transport (3 hours to pick up); 6
cars too old & can't repair; 1 donated vehicle is too
expensive to repair and run
Vushtrri QKMF
4
2
1 is fully equipped.
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8. THE CURRENT NETWORK BY MUNICIPALITY
Kosovo is currently divided into 34 municipalities, 3 of which are currently
regarded as pilot Municipalities, with 3 proposed new municipalities. The official
estimated populations3 in the current municipalities range from around 4000
(current Novo Berde) to nearly 400,000 (Prishtine). The following section briefly
summarises for each municipality the facilities, staff and urgent needs. The urgent
needs are those more specific to the particular municipality, and those common to
all municipalities outlined previously, such as EDL drugs, service and maintenance
budgets etc are not noted again here.
8.1
D ECAN
Decan Municipality is bordered by Peje, Junik (pilot) and Gjakove municipalities.
A border region municipality, about half of its area is a largely unoccupied
mountainous region. The furthest village from the QKFM, Mazenik, is 12 km away,
with a travelling time of 40 minutes by private transport due to a poor access
road. There is a punkt is this village, but it is not operational due to lack of staff.
Special circumstances
Decan is endemic for seasonal hemorrhagic fever.4
Facilities and staff
Decan has 121 staff working in a Main Family Medicine Centre (QKFM), 3 Family
Medicine Centres (QMF) (Irzniq, Isniq and Strellc) and 6 punkts (AMF) (Poberj,
Lumbardh, Gramaqel, Prapaqan, Prelep and Ratish), with the QKMF recording
97% of all services in the municipality. Facilities are also reported as serving
some of the villages in neighbouring municipalities Peje and Gjakova.
Staff comprises 27 doctors, of whom 9 are specialists, and 2 are residents; 5
dentists; 67 nurses; 10 technicians and 13 administrative and other support staff
working in the QKMF. Two of the specialists (gynaecologists) and 4 of the nurses
(midwives) work in the 4 bed Maternity Unit attached to the QKMF). Four of the
specialists are not part of the usual PHC structure – 2 internists, otolaryngology,
3
Estimates of population are from 2008 Financing estimates
Kosovo has 2 types of haemorrhagic fever - Crimea Congo haemarraghic fever – a mainly tick
borne disease, and Haemorrhagic fever with renal syndrome – a mainly rat carried disease
4
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and dermatology. A total of 7 doctors (including 1 FM specialist); 15 nurses; and 2
technicians work in the other facilities.
State of the buildings
The QKMF is a relatively new building (2000) and the emergency centre is new
(2008) and better equipped than other emergency centres. The buildings are well
maintained and clean, however there is no central heating and a lack of proper
drainage.
Urgent local needs
Although the emergency centre is superior, training is needed in emergency
medicine, there is no equipped, functioning auto ambulance, and there is a lack of
basic emergency drugs and other supplies.
8.2 DRAGASH
Dragash is located in the extreme south of Kosovo and is relatively isolated, having
access to the nearest hospital and specialist care, Prizren, by a long winding road
(average 50 minutes drive). It is viewed as one of the poorest municipalities, with
whole families (Kosovo Albanians) migrating, rather than single family members
as previously. The comparatively large Gorani community (about a third of the
population) is more elderly. The furthest towns from the QKMF are Restelice
(4,000 inhabitants) and Zaplluxhi (2000), 25km distance (and 2 hours to Prizren).
Special circumstances
With long winters and poor municipality road clearing ability, some villages are
isolated for days or weeks during the middle of winter, however health is reported
as generally good compared with more industrial areas of Kosovo.
Facilities and staff
Dragash has 98 staff working in a QKFM, 3 QMF (Krushev, Llopshnik, Rapqa) and 9
AMF (Kosav, Bellobrad, Bresan, Blaq, Brod, Kuke, Radesh, Restelic, Vraniq).
Staff comprises 6 doctors, of whom 2 are specialists; 3 dentists of whom 1 is a
specialist; 18 nurses; 10 technicians; and 20 administrative and other support
staff working in the QKMF. One of the specialists (gynaecologist) and 5 of the
nurses (midwives) work in the 16 bed Maternity Unit attached to the QKMF). A
total of 9 doctors (including a paediatrician); 17 nurses; 8 technicians; and 6
administrations and other support staff work in the other facilities.
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State of the buildings
The QKMF is in need of complete refurbishment, including roof replacement.
Water pipes are leaking, but the leaks are difficult to find and repaired.
Bresane is reported as needing a new building as the present one is falling
down (not assessed by us). It was reported that buildings are otherwise in
satisfactory condition except needing refurbishment, with no problems with
water or drainage.
Urgent local needs
Because of the relative isolation and time to hospital and specialist care, it is
felt a wider range of specialties are needed. The private sector is small, with
just one internal medicine specialist. Although the QKFM has an XRay, if a
broken bone is shown, there is nothing that can be done until the patient is
transported to Prizren. There is an urgent need for improved and expanded
emergency services, equipment and training.
8.3 FERIZAJ
All villages except a couple in mountains are within 20-30min of the QKMF.
Three new punkts have been built in Serbian villages but currently no staff
attend and no patients are using the facilities. A doctor comes from elsewhere
to visit patients in their homes.
Facilities and staff
Ferizaj has 308 staff working in primary health care which comprises a QKFM,
2 QMF (in Ferizaj) and 11 AMF (Bablak; Babushi; Gacke, Greme, Jezerce,
Komogllave, Mirash, Nerodime, Softaj, Talinovci).
Staff in the QKMF comprise 12 doctors, 3 are specialists other than in family
medicine; 12 dentists (3 of whom are specialists); 50 nurses; 34 technicians
(mainly dental) and 37 administrative and other support staff. An additional
26 doctors (of whom 4 are specialists other than family medicine); 67 nurses;
9 dentists; 25 technicians (mostly dental); and 13 administration and other
support staff are located in the other facilities.
In Ferizaj Municipality are also located a Hospital; an Institute for Public
Health; a Community Mental Health Care facility; an Integrated House for
Mental health and a TB unit with diagnostic ability.
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The 64 bed hospital has 219 employees, including 30 doctors and 127 nurses.
State of the buildings
The hospital is located in one building, with 2 floors and a basement. Drains
and roof are OK. They have nearly completed another building for a new
dialysis unit.
The hospital used to be the QKMF which was renovated, in parts, in 2001. It
lacks space and some specialties and there is a proposal to build a new
hospital. The drainage is adequate, but the facility needs complete
refurbishment to reach standard if no new hospital is built.
Urgent local needs
Dentistry staff is available and they have equipment, but lack materials so can
only treat small proportion of patients.
There is a need for a full emergency service and a proposal has been lodged.
8.4 FUSHE KOSOVE
Fushe Kosove Municipality lies on the outskirts of Prishtine toward Drenas.
The furthest village from the QKMF is 20 minutes away, by both public and
private transport.
There has been an attempt to at least partially integrate all inhabitants,
however the second floor of the QKMF allocated to Serbians patients remains
unused.
Facilities and staff
Fushe Kosovo has 103 staff working in primary health care in the
municipality, including 18 working in the parallel Serbian health system.
These facilities include a QKFM, 6 QMF (Fushe Kosovo, Albane e Ma., Bardh I
Madh, Kuzmin, Miradi e Ep., Miradi e Ulet)and 4 AMF (Bardh I Vogel,
Gureshkabe, Livragone, Punkti ashkali).
Staff comprise 18 doctors, of whom 3 are specialists, 8 are residents; a
biochemist; 2 dentists; 21 nurses; 25 technicians, administrative and other
support staff in the QKMF, and 9 doctors, 22 nurses and 8 support staff in the
other facilities.
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There is also an Integrated Mental Health House in Fushe Kosove.
State of the buildings
The building has recently been renovated well throughout by Norvac.
8.5 GJAKOVE
Another municipality viewed as among the poorest in Kosovo, Gjakove
borders Albania and has only 1 industry, a brick factory. A Memorandum of
Understanding with Albania allows people from Albania to be treated in
Gjakove when this is closer than their own health facilities.
Facilities and staff
Gjakove has 337 staff working in primary health care which comprises a
QKFM, 10 QMF (Gjakove (3), Brogova, Cermjan, Dardani, Ereniku, Orize,
Ponoshec, Skivjan)and 15 AMF (Bec, Brekoc, Danjan, Doblibare, Dol, Gergoc,
Guska, Korenice, Kralan, Lipovec, Moliq, Novoselle, Sheremet, Shqiponja,
Vishtazhin).
Staff comprise 73 doctors, of whom 4 are specialists other than in family
medicine (3 paediatricians, 1 internal medicine), and 8 are FM residents; 32
dentists, 10 dental specialists; 263 nurses; and 140 technicians, administrative
and other support staff.
In Gjakove Municipality are also located a Hospital; an Institute for Public
Health; a Community Mental Health Care facility; an Integrated House for
Mental health; and a TB unit with diagnostic ability; and an Institute of
Occupational Health providing tertiary outpatient care.
The 415 bed hospital has a total of 557 employees, including 64 doctors and
210 nurses.
State of the buildings
All PHC facilities less than 10 years old.
80% of the hospital buildings are viewed as satisfactory. They are generally
clean and maintained.
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8.6 GJILAN
Gjilan is bordered by both Serbia and Former Yugoslavia Republic of
Macedonia, less than 50 km from Prishtine.
Special circumstances
Rural to urban migration is reported to be very significant due to destruction
of villages and lack of infrastructure.
Facilities and staff
Gjilan has 328 staff working in primary health care which comprises a QKFM,
13 QMF (Gjilan (4), Bresalc, Cernice, Kufc e eperme, Malisheve, Miresh, Pasjan,
Perlepnice, Pograghe, Zheger)and 17 AMF (Budrige, Kisha e qytetit, Kishna
pole, Korotisht, Livoq I eperm, Livoq I poshtem, Llashtice, Makresh, Parallove,
Partesh, Ponesh, Shillove, Shurdhan, Stanishor, Strazh, Uglar, Verbic e
zhegovcit).
Staff in the QKMF comprise 23 doctors; 14 dentists; 51 nurses; 10 dental
technicians; 1 pharmacy technician; 9 laboratory technicians; 50
administrative and other support staff. An additional 33 doctors; 109 nurses;
13 dentists; 13 dental technicians; 8 laboratory technicians; and 10
administration and other support staff are located in the other PHC facilities.
Individual facilities have population catchments of 3000 to 17000 people.
In Gjakove Municipality are also located a Hospital; an Institute for Public
Health; a Community Mental Health Care facility; an Integrated House for
Mental health and a TB unit with diagnostic ability.
The 402 bed hospital has a total of 514 employees, including 100 doctors, 17
residents, 313 nurses, and 150 technicians.
State of the buildings
Existing hospital buildings are mostly in need of refurbishment, with
inadequate drains and water supply. We made 2 visits to this hospital - at the
start and end of the visit period. The new Director has concentrated on
improving hygiene and cleanliness, which was an urgent need. A number of
new buildings are in process, or are finished but unequipped and unstaffed.
The QKMF is old and unsuitable and larger rooms have been chopped up to
gain the space needed. They have plans to add a second floor rather than
build a second facility, as the building is centrally located, with a population of
40,000 within 5 minutes. However there is no parking available.
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Urgent local needs
Maintenance & refurbishing of existing hospital buildings including
improvement of infrastructure (sewerage & water), especially in the maternity
building.
8.7 GLLOGOC (DRENAS)
Another municipality viewed as one of the poorest, Gllogoc (Drenas) is
centrally located in Kosovo. Shortly there will be good road access to all
villages, reducing the travelling time from the 3 furthest villages to the QKMF
(which is currently 40 minutes). Forty minutes is also the travelling time to
the referral hospital, Prishtine.
Special circumstances
Drenas has a traumatized population with chronic psychiatric illness,
especially depression. There are seasonal health issues in rural areas
including Hepatitis A and hemorrhagic fever.
Facilities and staff
Gllogovc has 185 staff working in primary health care in the municipality.
These facilities include a QKMF with a 16 bed maternity unit, 5 QMF (Baice
(Rezistence), Gilaneselle (Shkabe), Komoran (Bushat), Orliat (Arllat),
Terstenik (Qendrese)) and 7 AMF (Abri e Eperme, Dobroshefc (Dritan),
Gradice (Dodone), Terdec (Grykas), Nekofc (Nikaj), Stankofc (Flamuras),
Vasileve (Paklek/Malesi)).
Staff comprise 21 doctors; 91 nurses; and 40 other technicians, administrative
and other support staff in the QKMF, and 11 doctors, 20 nurses; 2 laboratory
technicians and 7 support staff in the other facilities.
There is also an Integrated Mental Health House in Drenas.
The only private facilities of interest apart from the usual private practices of
the local publicly employed specialists, are 2 private surgeons in practice, one
of which has some beds.
State of the buildings
The Integrated Mental Health House is a brand new building, staffed and
waiting to commence providing services when viewed. There is a proposal to
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build a new building for the punkt in Vasileve (Paklek/Malesi) (current
building not viewed).
The QKMF used to use fuel heating but found it too expensive and has reverted
to coke. The roof is leaking badly and drainage is a big problem, with 3-4
toilets not functioning. Areas renovated under prior management already
show signs of poor renovation.
Urgent local needs
There is no pulmologist in the area, with an increase in TB cases. Access to
pulmology services, especially in the light of the level of new TB cases, will be
set by the Project Working Groups.
Emergency department improvements are needed with respect to space and
equipment.
8.8 HANI I ELEZIT
A small pilot municipality, Hani I Elezit is bordered by Kacanik Municipality
and Macedonia. The furthest villages are 7 km from the FMC, however there is
no public transport.
Special circumstances
Hepatitis A is a problem, with untested water associated with the local cement
factory suspected of being mixed with other municipality water.
Facilities and staff
Hani I Elezit has 18 staff working in primary health care in the municipality.
These facilities include the QMF in Hani I Elezit and 1 AMF (Gorance).
Staff comprise 4 doctors; 10 nurses; 1 laboratory technician; and 2
administrative and other support staff.
The FMC works only 2 shifts (7 am to 8pm - until 2pm on Saturday and
Sunday) and outside of these times, people go to Kacanik for primary health
care services (16 km- 15 min) or for hospital services to Ferizaj (36Km).
There are no laboratory, XRay or antenatal services available in the QMF.
State of the buildings
The FMC building is good, well maintained and clean, except for the
incinerator which needs total replacement.
Urgent local needs
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Because the minibus, which serves as the only ambulance, transports dialysis
patients to Gjilan 3 days a week, on these days there is no ambulance service
available for emergency cases in Hani I Elezit. A fully equipped ambulance and
a 4WD vehicle for dialysis and other patient transport are needed.
The QMF does not have a phone and staff lack emergency services training.
8.9 ISTOG
Istog is bordered by the mountains of Montenegro and is well connected to
both Peje and Mitrovice. It is a relatively healthy area apart from its highly
mineralized water. However all villages now are connected to water supply.
Facilities and staff
Istog has 126 staff working in primary health care in the municipality. These
facilities include a QKFM with a 14 bed maternity unit, 3 QMF (Gurakoc,
Rakosh, Vrell)and 9 AMF (Cerkole, Dobrush, Dubrav, Kaliqan, Osojan, Saradra,
Studenic, Veriq, Zaliq).
Staff comprise 21 doctors, of whom 6 are specialists other than family
medicine; 5 dentists; 39 nurses; and 32 technicians, administrative and other
support staff in the QKMF and 5 doctors; 4 dentists; 28 nurses; and 8 support
staff in the other PHC facilities.
The municipality is involved in an Intersource palliative care (mainly)
program where a specially trained team consisting of a doctor, nurse and
driver spends 1 week in each of 4 municipalities – Kline, Peje, Decan and Istog
– visiting patients in their homes. A patient education and monitoring
program for diabetes, hypertension, community and infection control is also
just commencing through the nursing college.
State of the buildings
There is a proposal to build a new QKMF as the current one (2 buildings) is 60
years old and has drainage, water and roofing problems (in danger of
collapsing in 1 building), despite a number of renovations over the years. The
building appears solid, but needs extensive internal and external work to
bring it up to health facility level. The XRay department is up a couple of
flights of stairs with no lift. Swiss Red Cross previously replaced the original
coke heating, but fuel costs were 50,000E a year, so the facility has returned to
the old coke heating again.
Urgent local needs
Mobile emergency team is needed, especially to cover hours after 3pm when
only one doctor is working in the emergency department.
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8.10 J UNIK
Junik is small pilot municipality bordered by the mountains of Albania. All
villages are less than 5km from primary health care (10 minutes), and up to 30
minutes to secondary care (Peje or Gjakove), by private transport.
Special circumstances
The municipality reports it has higher psychiatric conditions, hypertension,
and myocardial infarctions than other areas of Kosovo.
Facilities and staff
Junik has 22 staff working in primary health care in the municipality. These
facilities include a QFM which works 2 shifts – 7am to 11pm.
Staff comprise 4 doctors, 1 of whom is a family medicine specialist, 1 an
ophthalmologist, and 1 a resident; 2 dentists; 10 nurses; and 6 technicians,
administrative and other support staff.
State of the buildings – infrastructure & maintenance
The building is small and in poor state with drainage problems and no heating.
Urgent local needs
Vaccination services have not been fully established, with some key
equipment needed, including vaccine refrigeration and logistics support.
The municipality lacks a pharmacist technician.
8.11 KACANIK
The main hospital for Kacanik is Ferizaj, 20 km away, a 15-30 minute drive.
The furthest populated village is about 5-6 km away from the nearest punkt,
and 35 km (40 minutes) away from the QKMF. One other village is only 15 km
distance, but because of the road conditions, is 1 hour away from the QKMF.
About 98% of the population is covered by the current primary care network.
Some go to Viti when that QKMF is closer for them.
Special circumstances
Apart from the health conditions of concern all over Kosovo, the main health
issue in Kacanik is TB patients.
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Facilities and staff
Kacanik has 105 staff working in primary health care which comprises a
QKFM with a maternity unit (unofficial), 1 QMF (Kacanik te vjeter) and 8 AMF
(Doganaj, Begrace, Bicaj, Gure Zi, Lisnaje, Lum Bardhe, Qafe Shqipe, Stagove).
After 3pm all go the QKMF. The maternity unit does not have a gynecologist
on call at night so deliveries afterhours are transported to Ferizaj.
Staff comprise 25 doctors, of whom 1 is a specialist apart from family medicine
(gynecologist), and 4 are FM residents; 65 nurses; and 22 technicians,
administrative and other support staff.
Kacanik Municipality also has a TB unit without diagnostic ability (this had not
commenced operations when visited by us).
State of the buildings – infrastructure & maintenance
There have been partial renovations in the TB unit and emergency. The
downstairs area of the building is particularly unhealthy with leaking pipes
and fungal growth and plaster bubbling. The building needs refurbishing, with
total roof, doors & windows, drainage, central heating. Recently renovated
areas are already deteriorating in the main building.
8.12
KAMENICE
Kamenice Municipality has very spread villages, however they are generally
covered by primary care, except for a mountain village Policka.
Special circumstances
Renal problems are of concern.
Facilities and staff
Kamenice has 180 staff working in primary health care which comprises a
QKFM and 2 QMF and 12 AMF (Busavate, Desivojce, Hogosht, Karaqeve,
Kopernice, Koretine, Krileve, Lisocke, Muqiverce, Rogane, Shipashnice e
Eperme, Strezovc, Topanice, Tuxhevc). In addition in the parallel Serbian
facilities there are 2 QMF (Ranilug, Kamenice) and 9 AMF (Bosce, Ajnovc,
Kolloleq, Ropotove, Korminjan, Domarovc, Bozhevc, Rajanov, Bushince). The
Serbian population come to QKMF afterhours for laboratory and XRay.
Due to the parallel health systems, some of the facilities are within 2 km of
each other.
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Staff in the Albanian facilities comprise 16 doctors, of whom 6 are specialists
(1 paediatrician, 1 gynecologist, 1 internal medicine), and 3 are FM residents;
1 dentists; 78 nurses; and 23 technicians, administrative and other support
staff.
State of the buildings
There are problems with the infrastructure of many of the punkts and QMF – 6
have no water and also have drainage problems. The QKMF consists of a
number of buildings in a variety of conditions. One is in particularly bad
condition with an asbestos roof, and 3 have drainage problems.
Urgent local needs
The main problem is old buildings with old equipment.
8.13
KLINE
The QKMF in Lipjan (25000 population) is 25 km from Shale (6000); 17 km
from Janjeve (5000); 15 km from Magure (8000), Gadime (10000); Babush
(2000); Banulle (2000); 13 km from Dobraje (2000); 10 km from Kraishte
(2000), Sllovi (4000); 6 km from Robvc (2000); 5 km Banulle(2000).
Facilities and staff
Kline has 138 staff working in primary health care which comprises a QKFM
with maternity unit, 3 QMF (Sjerk, Ujmir, Zllakuqan) and 9 AMF (Budisallc,
Cerovik, Drenoc, Gllareve, Grabanic, Jagod, Jashanic, Jashanic, Shtupel).
Staff comprises 24 doctors, of whom 8 are specialists (4 paediatricians, 2
gynecologists); 1 dentists, 1 dental specialists; 78 nurses; and 37 technicians,
administrative and other support staff.
In Kline Municipality is also located a TB unit with diagnostic ability.
State of the buildings
The QKMF has recently moved into a new building, which shows signs of being
poorly built, with roof already leaking. Their CT scan has been left in the old
building because it is water damaged. Their fully equipped maternity unit is
not operating currently, although they have midwife staff.
Urgent local needs
Although the emergency department has been recently renovated, it is small,
dark and windowless and further renovations are commencing.
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8.14
LIPJAN
The furthest village from the QKMF is 45 km – 1 hour travelling. This village is
8 km (30 minutes) from Shala QMF.
Facilities and staff
Lipjan has 270 staff working in primary health care which comprises a QKFM,
4 QMF (Magure, Shale, Gadime, Janjeve) and 6 AMF (Sllovije, Kraishe, Robovc,
Babushe, Dobraje Banulle).
Staff comprise 42 doctors, of whom 4 are specialists; 2 dentists, 4 dental
specialists; 147 nurses; and 63 technicians, administrative and other support
staff.
In Lipjan Municipality is also located a TB unit without diagnostic ability.
State of the buildings
The QKMF consists of 3 buildings of which 2 have leaking roof problems. The
floor is particularly bad and the roof is leaking in the maternity area and the
toilets are a big problem.
Urgent local needs
Refurbishment of the building is needed and they only have 1 functioning
autoambulance.
8.15
Malisheve
Malisheve Municipality has the highest number of haemorrhagic fever.
Malisheve contracts out its dialysis patient transport for 6000E/year for their
16 dialysis patients and is very satisfied with this decision. They supply drugs
to social need cases through tenders of 10,000E/year.
Facilities and staff
Malisheve has 122 staff working in primary health care which comprises a
QKFM with a 14 bed maternity unit, 1 QMF (Kiev)and 11 AMF (Bellanic,
Ceralluk, Dragobil, Drenoc, Fshati I ri, Kavaqari, Lozic, Lumizad, Pagurush,
Panoc, Terpez).
Staff comprise 15 doctors; 2 dentists; 53 nurses; and 28 technicians,
administrative and other support staff.
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In Malisheve Municipality is also located a TB unit with diagnostic ability.
State of the buildings
The large building is in good condition.
Urgent local needs
XRay is nearly collapsed – staff must hold a piece of the machine during
XRaying, clearly a safety issue.
The QMF and Panoc punkt need connection to water supply.
8.16
Mamushe
Average time to get to Prizren Hospital is 30 minutes.
Special circumstances
A small pilot municipality with only one doctor and one dentist.
Facilities and staff
Mamushe has 8 staff working in primary health care which comprises a QKFM.
The QKMF can only work one shift due to lack of staff. No home visits are
possible.
Staff comprise 1 doctor; 1 dentist; 5 nurses; and 1 and other support staff.
State of the buildings
They are expecting to move shortly into their new building, although the
present one is also quite good.
Urgent local needs
No laboratory available due to lack of trained staff, although they have a lot of
new, unpacked, laboratory equipment including a fully automated
haematology cell counter.
8.17
Mitrovice South
There are a large number of internally displaced persons (IDP) in Mitrovice,
and only 10% of patients are levied with a copayment. Most villages are
within 30 minutes of Mitrovice, with the furthest punkt 35 km away (but this
town has practically no people), with a travelling time of an hour or more.
Special circumstances
The hospital for Mitrovice Municipality before the war was north of the river.
A temporary hospital since then has been established in the QKMF, with an
annex built to house a number of functions including a dialysis unit. The
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hospital and QKMF share many services including emergency, laboratory and
specialist services. While waiting for the political situation to be resolved, the
hospital has missed the type of donor and other investments that other
hospitals have received.
Facilities and staff
Mitrovice Sth has 275 staff working in primary health care which comprises a
QKFM, 6 QMF (Shipol, Ilirida, Tuneli I pare, Shupkofc, Sheshi I vjeter,
Koshtove) and 15 AMF (Bare, Bair, Kciq, Guchafc, Fidanishte, Caber, Kodra e
Minatoreve, Rashan, Zhazhe, Broboniq, Vilahi, Bajgore, Kaqanoll, Selac,
Zabergje, Bistrice).
Staff comprise 32 doctors, of whom 14 are family medicine specialists; 9
dentists; 149 nurses; and 171 technicians, administrative and other support
staff. In addition, Mitrovice Municipality staffs and operates 3 AMFs serving
people there who want to use the Kosovo health system (KA) in Leposavic,
Zvecan and Zubin Potok municipalities.
In Mitrovice Municipality are also located a hospital; a Community Mental
Health Care facility; and an Integrated House for Mental health.
The bed hospital has a total of employees, including 38 doctors and 177
nurses.
State of the buildings
The QKMF is an old typical multistoried building with wide corridors around a
central light well, into which small hospital departments have been added,
including into some corridors. It is not to standard as a health facility and is
difficult to keep clean and hygienic, and there are problems with the drains.
Due to its inner city location, there are access problems for the ambulances
and there is no patient parking.
Urgent local needs
Some land and buildings have been donated and work has started on replacing
the hospital in stages, with new buildings and renovations of the donated
buildings. Ensuring that the secondary care needs of people in this area are
met will form part of the Master Plan.
8.18
Novo Berde
Novo Berde is a small municipality not far from Prishtine, which is planned to
increase in size. It is regarded as one of the poorest in Kosovo. Currently
separate health facilities serve KA and people in Kosovo wishing to use the
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Serbian health system (KS). The facilities are 8 km apart, but many
inhabitants do not have transport. If properly staffed the facilities would
adequately cover population needs. 80% of the G&S budget is spent on
transporting 2 haemodialysis patients to Gjilan. Currently this is partially
covered by donations.
Facilities and staff
Novo Berde has 7 staff working in primary health care (plus Serbian staff)
which comprises a QKFM, 3AMF (Prekov, Llabjan, Tuller).
Staff in the KA facilities comprise 1 doctor; 4 nurses; and 2 support staff.
State of the buildings
The building has been recently renovated, although not to health care
standard.
Urgent local needs
There are no dental services though the space is available. Laboratory
services commenced recently, but no XRay services are available. The
municipality has no emergency transport while the only vehicle is in Gjilan
with haemodialysis patients. The QKMF has a 4WD ambulance that, if
repaired, would address this need.
8.19 O BILIQ
Obiliq Municipality is close to Prishtine and reports significant pollution from
the ash heaps from the power station, believed to be responsible for the
increases in cancer in the municipality.
Facilities and staff
Obiliq has 99 staff working in primary health care which comprises a QKFM, 1
QMF (Mllosheve)and 4 AMF (Breznice, Palaj, Shipitull, Siboc).
Staff comprise 18 doctors; 4 dentists; 56 nurses; and 22 technicians,
administrative and other support staff.
State of the buildings
The building was renovated this year and has heating and airconditioning with
generator, serving some parts of the building. However poor drainage has
caused one toilet to be closed, and the roof leaks in the annex which was
renovated in 2006.
Urgent local needs
Need 2 ambulances (1 they have is not fully equipped & functioning)
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8.20
PEJE
Peje is a large municipality on the western side of Kosovo, bordered by
mountains leading to Montenegro.
Facilities and staff
Peje has 318 staff working in primary health care which comprises a QKFM, 7
QMF (Peje (5), Radavc, Vitoramic, Zahaq) along with an Emergency Center, a
Mother & Child Center, Paediatrician Center, Dental Center) and 17 AMF
(Raushiq, Loxhe, Baran, Leshan, Poqeste, Trestenik, Ozrim, Trebovi, Doberdo,
Cryshec, Kryshec, Gllogjan, Novosell, Tenic, Drelaj, Gorazhd, Haxaj).
Staff comprises 11 doctors, of whom 2 are specialists (1 gynecologist, 1 other);
1 dentists; 9 nurses, of whom 2 are midwives; and 9 technicians,
administrative and other support staff; and in the other facilities 70 doctors, of
whom 11 are specialists (9 paediatricians, 1 gynecologist); 139 nurses
(including 4 midwives); 24 dentists, of whom 9 are specialists; and 47 others.
In Peje Municipality are also located a Hospital; an Institute for Public Health;
a Community Mental Health Care facility; an Integrated House for Mental
health; and a TB unit with diagnostic ability.
The 448 bed hospital has a total of 557 employees, including 105 doctors, 4
residents, and 299 nurses.
State of the buildings
The QKFM has been moved to a fairly isolated location away from the centre of
the city, unsuitable for the main primary care service, leaving some parts of
the primary care (mother and child with paediatricians) in the city centre.
The hospital has 6 separate buildings which are in basically good condition,
except for one with drainage problems. Needing renovation in some parts.
Urgent local needs
Rationalisation of the primary care buildings, with improvement of locations.
8.21
P ODUJEVE
Podujeve Municipality is on the eastern edge of Kosovo, bordered by Serbia.
The settlements are within 30 minutes of the QKMF.
Special circumstances
They have been contemplating contracting out cleaning services and
employing professional staff with the money saved. They are working in a
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project to develop primary care protocols in hypertension, diabetes, acute
otitis media, and conjunctivitis.
Facilities and staff
Podujeve Municipality has 246 staff working in primary health care which
comprises a QKFM with a 6 bed maternity unit, 14 QMF (Lluzhan, Kerpimeh,
Podujeva 2, Gllamnik, Bradash, Bajqin, Orllan, Majac, Pollat, Batllav, Halabak,
Sfecel, Shajkovc, Llapashtic)and 7 AMF (Dumnic, Dobratin, Dyz, Murgull, Lupc i
poshtem, Livadic (Livadhishe), Hertice).
Staff comprises 59 doctors, of whom 10 are specialists other than family
medicine (1 internal medicine, 1 ophthalmologist, 2 pulmologists,
dermatoveneralogist, psychiatrist, radiologist, gynecologist, epidemiologist); 4
dentists; 124 nurses; and 69 technicians, administrative and other support
staff.
In Podujeve Municipality are also located a Community Mental Health Care
facility and a TB unit with diagnostic ability.
State of the buildings
There are 4 buildings - a large polyclinic building, renovated and in good
condition; a new building for an emergency centre which they are equipping
(they have not moved into at the time of the visit); an old administration
building which includes the maternity unity, in fairly poor condition; family
medicine and dentistry building fairly recently renovated but in fairly poor
condition. Drainage and leaking water pipes are the main problem.
Urgent local needs
Renovation of drainage and improving water quality.
8.22 P RISHTINE
Prishtine Municipality surrounds the capital city and has the largest
population.
Special circumstances
QKUK is the only general hospital in the area. This, combined with a relatively
weak primary care sector, means that many patients turn up at the hospital
with conditions that would more appropriately be handled within the
secondary care or primary care environment. Seven of the top 10 conditions
treated at QKUK are Ambulatory care Sensitive Conditions, in other words for
conditions that in most cases should be effectively prevented or handled with
primary care. This puts an enormous strain on the facility and in an
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environment where the maintenance budget is quite limited, it quickly results
in unacceptable levels of maintenance and cleanliness.
The Municipality has recently announced approval for the building of 4 new
QMFs.
Facilities and staff
Prishtine has 832 staff working in primary health care which comprises a
QKFM, 15 QMF (Prishtine (6), Besi, Hajvali, Keqekoll, Kishnice, llukar, Matiqan,
Mramor, Rimanisht, Shkabaj, Sliviv), a dental clinic, a City Emergency Centre
(CEC), and 7 AMF (Bardhosh, Barilev, Bullaj, Flotacion, Koliq, Shashkovc, Viti).
Staff comprises 226 doctors, of whom 32 are specialists (3 emergency; 2
psychiatrists; rheumatologist, 14 dermatologists; 4 pulmologists; hygienist; 8
occupational medicine; 23 dentists, 18 dental specialists; 367 nurses; and 259
technicians, administrative and other support staff.
Prishtine Municipality also has a Hospital; the National Institute for Public
Health; a Community Mental Health Care facility; and a TB unit with diagnostic
ability.
The 1931 bed hospital serving the Prishtine municipality, Prishtina University
Clinical Center (QKUK) is also the tertiary referral center for the whole of
Kosovo. There is no separate secondary care hospital. It has a total of
employees, including 576 doctors and 1084 nurses.
State of the buildings
The 3 storey QKMF is in good condition except in the XRay and laboratory
areas which have damaged floors. A relatively high patient load at QKUK
compared to the Regional Hospitals, combined with the poor maintenance of
the facilities, results in the hospital being in poor shape in regard to hygiene
and cleanliness. There are differences however in this regard between
departments, which may in part be due to the fact that some buildings are in
particularly poor condition in terms of infrastructure, and in part because of
variation in management capability between departments.
All hospital buildings suffer to a greater or lesser degree from poor
maintenance, but some buildings are probably beyond repair eg the General
Psychiatry/Neurology building. Other buildings appear basically sound, such
as Pediatrics, but would require extensive internal renovation to bring them
up to a basic standard.
There are also some examples of relatively recent constructions, where there
is doubt about the quality of the construction and suitability for its intended
purpose, such as the Oncology building. In some buildings, eg Psychiatric ICU,
the recent construction appears to have been of acceptable standard.
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The Emergency Center is one of the busiest areas of the hospital and as a
result is in relatively poor shape, both in terms of equipment and
infrastructure.
Prishtina City Emergency Center
This is a relatively new facility located close to the University Clinical Center
and is the primary source of emergency services in the Municipality of
Prishtina coordinated by a call center for auto ambulances within the City
Emergency Center. The building is well designed and in excellent condition, as
well as being well supplied with equipment and drugs. It operates 24 hours
per day and provided services to 138,000 people in the last 12 months. The
service includes 10 teams, comprising a doctor, a nurse and a driver, with two
teams being on call at any one time.
There are however a number of issues that limit the service’s effectiveness.
While there are 12 vehicles at the center, there are only 2 fully equipped autoambulances that are suitable for this type of service. These vehicles were
donated from Japan several years ago. In addition there are two less equipped
but functional auto ambulances as well as one Toyota 4X4 and a Lada Niva.
This appears to be inadequate for population.
An additional issue is the interaction of the City Emergency Center with the
Emergency Center at the University Clinical Center, which is located a short
distance away. Entrance to the University Emergency Center should be by
referral whereas the City Emergency Center is a primary care facility, so
requires no referral. In reality the majority of patients prefer to go directly to
the University Emergency without referral, presumably because of the
availability of specialists. This leads to the unsatisfactory situation where the
University Emergency is overloaded and in very poor condition, and with poor
availability of equipment and drugs, while the City Emergency next door is
fully equipped but underutilized.
The location and function of the Emergency Services, including the number
and location of the emergency vehicles and also the rationalization or
consolidation of the existing emergency facilities will be a specific strategy
developed in the Master Plan. This strategy will also deal specifically with the
issue of associated activities such as laboratory services, radiology support
services and the proximity to suitable operating theatres.
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8.23
PRIZREN
Prizren is a large municipality towards the south of Kosovo. Its health
conditions other than those common to all Kosovo are higher breast cancer
and seasonal brucellosis and haemorrhagic fever.
Facilities and staff
Prizren has staff working in primary health care which comprises a QKFM, 11
QMF (1 in Prizren, Gjonaj, Hoqe e qytetit, Korishe, Lakuriq, Pirane, Ralin,
Reqan, Romaje, Zhur) and 20 AMF (Arbane, Dardani, Granqoar, Jabllanice,
Kushmine I Hasit, Libeqeve, Lubinje e poshtme, Lubishte e Prizrenit, Lubna e
eperme, Lugishte Has, Manastirice, Mushnikove, Nashec, Planej, Skorobishte,
Strugje, Veleshe, Vllashnje, Zym Has).
Staff comprise 61 doctors; 26 dentists, 12 dental specialists; 274 nurses; and
57 technicians, administrative and other support staff.
In Prizren Municipality are also located a Hospital; an Institute for Public
Health; a Community Mental Health Care facility; an Integrated House for
Mental health; and a TB unit with diagnostic ability.
The 578 bed hospital has a total of 759 employees, including 160 doctors and
399 nurses. Security guards and kitchen staff have been outsourced, resulting
in savings.
State of the buildings
Part of the hospital is a new building but back stairs, and the new part of the
building are unmaintained with incomplete cleaning and broken windows and
tiles, on its way to become unmaintained.
More than 95% of the equipment in the hospital is working, being maintained
by their own trained engineers. Calibration provided by outside firms,
however the qualifications of firms in Kosovo providing calibration was
questioned.
The hospital has a fully equipped physiotherapy department seeing 120-130
patients/day, with a waiting list of 2-3 weeks.
A conference and retail centre is planned to be started this year, financed by
in- advance rents from retailers.
Urgent local needs
Training in Diabetes management is needed and also diabetes screening.
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No mammography is presently available in Prizren, though they have a
radiologist trained.
They have most of the equipment for endoscopic surgery which would allow
reduction in length of hospital stays, but staff lack training.
8.24
RAHOVEC
The furthest village from the QKMF is Mrasor – 42 km away – 1 hour by car.
70% of the population lives in villages and 30% in the city, but there is a good
PHC network and due to good infrastructure, access is satisfactory.
Special circumstances
Rahovec claims a lower unemployment rate than other municipalities due to a
large organized private agricultural industry, including wine. There is a high
level of renal failure and the cases of hemorrhagic fever are the highest after
Malisheve.
Facilities and staff
Rahovec has 129 staff working in primary health care which comprises a
QKFM with a maternity unit, 4 QMF (Fortes, Krusha e Madhe, Qifllak,
Ratkoc)and 3 AMF (Drenoc, Hoxha e madhe, Lagja veriore Rahovec).
Staff comprise 19 doctors; 47 nurses; and 34 technicians, administrative and
other support staff working in the QKMF, and 6 doctors; 21 nurses; and 7
technicians and other support staff working in the other PHC facilities. A
gynaecologist and midwives work in the 16 bed Maternity Unit attached to the
QKMF).
Rahovec Municipality also has a TB unit without diagnostic ability.
State of the buildings
The QKMF has 3 usable buildings and a number of buildings which need to be
demolished. Two are in poor condition and one, housing XRay and Emergency
Department, is new. They have a contrast-capable XRay, but no radiologist
and the emergency centre has no equipment.
Urgent local needs
A number of buildings need to be demolished, and the main building needs
complete refurbishment. After refurbishment, and redesign, there would be
enough space to house the functions currently housed in the third building.
The second building has very poor drains and is built close to a cliff face and
renovating this poorly sited building is questionable.
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There is no psychiatric service in Rahovec and no suitable transport to
Gjakova for disturbed patients.
8.25
SHTIME
Shtime Municipality is 20 minutes from Prishtine (depending on the time of
day).
Facilities and staff
Shtime has staff working in primary health care which comprises a QKFM, a
QMF (Muzeqine) and 2 AMF (Petrove, Pjetershtice).
Staff comprises 19 doctors, of whom 4 are specialists (2 paediatricians, 2
internal medicine); 2 dentists; 40 nurses; and 18 technicians, administrative
and other support staff.
State of the buildings
The QKMF is satisfied with the renovation of their building of 2007 and rate
the building as excellent, with airconditioning in emergency, laboratory and
dentistry.
Urgent local needs
Have only 1 functioning equipped autoambulance.
Integrated Centre for Mental Health
The Integrated Center for Mental Health is located in Shtime. It serves the
whole of Kosovo and has 62 long stay psychiatric patients. No new patients
have been admitted for some time. There is a total of 40 staff of which 12 are
general nurses. The only doctor is the Director of the facility (previously a
psychiatrist, the new Director is a family medicine specialist.)
As a health care facility in general, and as a psychiatric facility, the care
provided is very inadequate. There are numerous inadequacies but the more
obvious ones are:




A limited review of medications prescribed and dispensed suggests
that over 90% of prescribed drugs are not available and therefore not
dispensed, as these patients usually do not have family members who
can buy medications privately
There indications that patients may not be reviewed regularly with
regard to their general medical health
Heating is inadequate and there is no operational backup generator
The bedding is inadequate or non existent
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

There are very little or no daily activities for the patients, such as
television, books, board games, external trips etc
Inadequate and unreliable transportation in the event of medical
emergencies.
The situation at this facility has been obvious since investigations in 2000,
2001 and 2002, however the same items of concern continue. The patients
should be transferred immediately to other facilities as an interim solution. A
longer term strategy for mental health and how best to utilize the current
facility will be developed as part of the Master Plan.
State of the building
The Centre comprises a single structure with 3 floors and a basement, the
exterior of which is in reasonably good overall condition. The interior
however is not in good condition and would need significant work to raise it to
a reasonable standard. There are signs of leaking drains and the toilets are in
extremely poor condition.
8.26
SKENDERAJ
Again thought to be one of the poorest municipalities in Kosovo with high
unemployment.
Mitrovice used to be the referral hospital, however now all emergency cases
go to Prishtine, with some going to Vushtrri, where people have been satisfied
with the service.
Facilities and staff
Skenderaj has 176 staff working in primary health care which comprises a
QKFM with a 15 bed Maternity Unit, 5 QMF (Likoc, Prekaz I eperm, Qirez,
Runik, Turiqec) and 8 AMF (Aqareve, Izbice, Kline e eperme, Kllodernice,
Llaushe, Polac, Qubrel, Rezall).
Staff comprises 20 doctors (including 2 gynecologists working in the
maternity unit); 5 dentists; 78 nurses; 10 technicians and 31 administrative
and other support staff working in the QKMF. A total of 4 doctors; 34 nurses;
and 8 support staff work in the other facilities.
In Skenderaj Municipality is also a TB unit with diagnostic ability.
State of the buildings – infrastructure & maintenance
The building, from 1970, was partly renovated in 2006, but this was but
poorly done and the internal wall plastering is already flaking and pipes are
leaking. They use coke heating due to the cost of fuel and their generator old.
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The water supply is poor. The building has a reservoir, but no pipes to
distribute water from it.
Urgent local needs
They are having trouble getting an additional Family Medicine specialist as
they are 55 km from Prishtine and fuel is no longer covered. Due to the
relatively long travelling time to secondary care, an increased range of
services, especially in emergency care, are needed.
8.27
SHTERPCE
Shterpce is a mostly mountainous municipality bordered by Macedonia. Its
population is estimated to be 35% being Kosovo Albanian and 65% Kosovo
Serbian. Roads are not generally good, with worsening access problems
during winter.
Special circumstances
Shterpce highlights the health care problems that can occur when multiethnic
communities in Kosovo are not well integrated. Not only does the level of
health care services that is available to the communities differ, but there is
also inevitable duplication of services and wastage.
Facilities and staff
All the population can in theory access any of the facilities and in certain
circumstances do, however in the normal course of events the Serbian
community choose to access any of the 35 Serbian doctors located at the
QKMF, 7 AMF and one multiethnic QMF. The KA has access to 1 doctor (total of
16 health sector employees) shared between one AMF and one multiethnic
QMF. The Kosovo Serbian population also has access to 6 auto ambulances.
The KA has access to one vehicle.
KA dialysis patients are transported to Gjilan Hospital for dialysis using the
only official vehicle, thereby leaving the remainder of the population without
access to emergency transportation on 3 days a week. KA patients requiring
laboratory tests or Xrays are usually sent to Ferizaj Regional Hospital,
although it is possible for them to undertake such tests at the QKMF.
The KS, while they appear to have greater access to medical personnel and
facilities, also have some difficulties, particularly if they require to be
transferred to a higher level of care. Dialysis patients for example usually
chose to go to Belgrade (or sometimes Nth Mitrovice), tying up the auto
ambulances for a considerable period of time.
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There are also differences in the availability of pharmaceuticals. The Serbian
facilities receive their drugs from Belgrade and report no systematic
difficulties in supply, whereas the Albanian facilities suffer from the
medication supply shortages that have been reported throughout Kosovo.
The salaries of the health workers are also dramatically different between the
sectors.
State of the buildings
The multiethnic QMF is small but in reasonable condition. The punkt serving
KA is the only public building in its village and is used for many purposes
other than as a health facility. There are some drainage problems but
otherwise is reasonable.
Urgent local needs
Equipped autoambulance for emergency response and transport.
8.28
SUHA REKE
One QMF is 10 km away – 30 minutes travelling time – but the rest are within
5 km of Suha Reke. Diabetes and hypertension are increasing and Kasterc,
Nishor, and Mushtishi have some chronic nephritis.
The referral hospital, Prizren, is 20 km distance. There are no specialists or
mental health care center in Suha Reke.
Facilities and staff
Suha Reke has 151 staff working in primary health care which comprises a
QKFM with Maternity Unit, 3 QMF (Gjinoc, Mushtischt, Studencan)and 7 AMF
(Bukosh, Duhel, Drejkoc, Mohlan, Nishor, Samdregje, Sopi).
Staff comprises 21 doctors, of whom 3 are specialists other than in family
medicine (including a pediatrician and a gynecologist); 8 dentists, including 1
dental specialist; 80 nurses, including 13 midwives; 19 technicians and 15
administrative and other support staff working in the QKMF. A total of 7
doctors; 5 dentists; 27 nurses; and 10 support staff work in the other facilities.
State of the buildings – infrastructure & maintenance
The laboratory and XRay areas have been inspected by occupational health
and apparently assessed as too small for safe work. The vaccination center is
accessed past areas of ill patients and a separate entrance is needed. This
applies to other centres as well. Pipes are leaking.
Urgent local needs
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They have requested training in emergency medicine; family medicine;
diabetes management; hypertension; and respiratory diseases, as they wish to
prioritise prevention activities. There is a large need for mental health care in
the municipality
8.29
VITI
Again Viti is described as the poorest municipality in Kosovo. There are 47
villages, with 14 km from the furthest village to the QKMF and 20 km to Gjilan
Hospital. There is endemic Balkan nephropathy. As there is no screening, it is
likely that there are more cases than known about. Transporting patients for
dialysis is a load on the municipality, with a 3 hour collection and 3 hour drop
off, three times a week.
Viti QKMF used to have a mental health centre, but now patients go to Gjilan,
and there is no coordination of care with the QKMF.
Facilities and staff
Viti has 55 staff working in primary health care which comprises a QKFM, and
14 AMFs (Begunc, Debelldeh, Gjylekar, Kllokot, Letnic, Pozheran, Remnik,
Sadovin, Sllatin, Smir, Stubell, Terpez, Verbovc, Zhiti).
Staff comprises 12 doctors, of whom 3 are residents; 2 dentists; 61 nurses; 4
technicians and 20 administrative and other support staff working in the
QKMF. A total of 9 doctors (including 2 residents); 31 nurses; and 3
technicians and support staff work in the other facilities.
State of the buildings – infrastructure & maintenance
6 punkts need renovation – 1 in Pozheran (10,000 people) is an annex to
police station.
The main building is the typical many floors with central light well, large
building. Both QKMF buildings need renovation especially the doors and
windows in the main QKMF, as heating inefficient (50% goes on heating).
Urgent local needs
The emergency department is in very poor condition and is cramped and
lacking equipment. It could be moved to the vaccination building where there
is space, if the leaking roof and resulting damage was repaired.
8.30
VUSHTRRI
The town of Vushtrri is located 10-15 minutes away from Mitrovice.
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Facilities and staff
Vushtrri has staff working in primary health care which comprises a QKFM, 5
QMF (Lumi Bardh, Maxhunaj, Smrekonice, Novolan, Pantine) and 7 AMF
(Dumnice, Druar, Dubofc, Samadrexhe, Ashlan, Strofc, Ceceli).
Staff comprise 25 doctors, of whom 3 are specialists other than in family
medicine (paediatrician, biochemist and 1 other; 5 dentists, including 1
specialist; 121 nurses; 7 technicians and 17 administrative and other support
staff working in the QKMF. A total of 14 doctors; and 35 nurses work in the
other facilities.
In Vushtrri Municipality are also located a Hospital which has 78 beds and a
total of 123 employees, including 20 doctors and 75 nurses and technicians.
The QKMF and the hospital are co located and share laboratory, XRay,
emergency, paediatric and dental services (located within the hospital, with
staff and supplies coming from both facilities.
State of the buildings
The QKMF was built 2 years ago in the grounds of the hospital. However it
was not built to health facility standards, with narrow corridors and small
consulting rooms.
All QMF are in rural areas and have very little in them. They were all
renovated after the war by various donors but can’t be properly maintained.
The hospital used to be the QKMF and it has been renovated and equipped by
UAE. It was completed in 2003 and the last renovations (roof) were in 2006,
however the roof is still leaking over the kitchen and laundry. Drains, water,
airconditioning and central heating are all OK.
Urgent local needs
If the hospital had more staff, it could admit more people. Staff currently has
to do double shifts and deal with more patients than is standard practice.
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9.
NEXT STEPS
1 CONTINUE GATHERING INFORMATION
Facilities are being asked to fill data gaps to the extent they can, and are being
asked to confirm data when the sources have varied. The process of
conducting interviews and site visits will continue as issues arise that need to
be investigated in detail. Full data about the developing parallel Serbian
health care system in Kosovo has not yet been fully collected. This collection
will also continue.
2 EXPERT WORKING GROUPS AND WORKSHOP
A number of expert Working Groups have been established and have
commenced deliberations about health priority areas, health services and
equipment. It is planned to hold a Workshop in August/September to explore
Kosovo’s health network parameters. Once these activities have resulted in a
set of health priorities and planning parameters for the health care network,
the Investment Plan Working Group will commence their deliberations.
3 PRESENT GIS DATA TO THE WORKING GROUPS
In order to assess the impact of potential changes on the operation of the
health network, it is useful to present the information in the form of GIS maps.
Work is already underway to gather the data necessary to compile such maps.
Separate maps will be compiled for each of the significant aspects of the
network, such as specialty bed numbers, staff numbers and major equipment
location. The impact of changing the location of particular elements of the
network can be visualized through the GIS maps. The main use of the GIS will
be to assist the various expert Working Groups in making their decisions.
4 PREPARE SEVERAL ALTERNATIVE NETWORK OPTIONS FOR DISCUSSION
Following the agreement within the Working Group on the choice and level of
each of the planning parameters, then a reconfigured network will be
designed based on these parameters. As there are often multiple ways to
achieve a similar objective, it is possible that several alternative options will
be developed and presented to the Working Group and on to the Permanent
Secretary of the MSH.
5 DEVELOP IMPLEMENTATION PLAN FOR PREFERRED NETWORK
After the development of the various network scenarios, it is anticipated that
discussions will then follow on the merits of different approaches. After a
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decision has been made on the preferred model, a detailed implementation
plan will be developed which will describe at facility level the changes that will
need to be made to achieve the new network.
6 PREPARE CAPITAL INVESTMENT PRIORITY LIST
An important aspect of the reconfiguration strategy will be the listing of the
major changes that need to be made to existing facilities. This is where the
inventory that has been developed in each facility will become essential. A
capital investment list will be developed through this project that will assist
the MSH and MEF in deciding which of the many capital investment
applications they receive, are consistent with the reconfigured network, and
the relative priority of each.
7 MONITORING AND EVALUATION PLAN
During the various interviews conducted as part of the project to date it is
clear that all facilities are routinely gathering a considerable quantity of
detailed information on the services they provide and their inventory. It
appears however that they are not all consistent in format, meaning that it is
unlikely that this information is being used to maximum benefit.
A number of centrally designed structures are in place that could be used as
the basis or an effective monitoring and evaluation program. One of the
outputs of this project will be a suggested process for gathering data from
facilities in a consistent format and suggestions as to how that information can
be used.
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APPENDIX I – P EOPLE INTERVIEWED DURING DATA COLLECTION
Permanent Secretary MSH - Ilir Rrecaj
Deputy Minister of Health - Mybera Mustafa
Fatime Qosaj – Adviser
MSH personnel
Ismet Abdullahu – Shef Mental Health
Pashk Buzhala – Shef Public Health
Hazbija Fazliu - Shef Minorities
Curr Gjocaj – Head Health Services
Valdet Hashani – Head PHC
Fetije Huruglica - Shef Nursing Division
Ismet Hyseni – Shef Procurement
Zef Komoni – Health Inspectorate
Nexhdet Kondirolli - Director Dept Pharmacy
Iljaz Miftari – Shef HR Division
Arberesha Turjaka – Projects Coordination
Health Master Plan Project Working Groups
Health Services Working Group:
Chairman: Curr Gjocaj
Sevdije Bajraliu
Basri Lenjani
Teuta Qilerxhiu
Drita Fazliu
Shemsedin Dreshaj
Agron Kasumi
Sami Spahiu
Majlinda Gjocaj
Arsim Qavdarbasha - Dir Health
Commissioning Agency
Kadrije Ratkoceri CPD Board
Haki Sfishta - Finance Department
Njazi Shala – Shef Reproductive & Maternal
Health
Xhevat Ukaj – Shef HIS
Genc Ymerhalili - Head Centre for Family
Medicine
Ilirian Zymberaj – Sanitary Inspectorate
Health Priorities Working Group:
Chairman: Naser Ramadani
Pashk Buzhala
Ymer Elezi
Njazi Shala
Luan Jaha
Other Agencies
Valbona Bogujevci Department for International Development
Naim Kelmendi, Ministry of Transport, Head of GIS
Les Cheesman- Team Leader Transport Planning Strategy
Bashkim Bellaqa – Statistics Organization of Kosovo
Kadri Sojeva Director Department Population Statistics
Naser Ramadani Director National IPH
Merita Berisha – Head IT Strategy Committee, NIPH
Nexhat Krasniqi - Director Dept HIS & Medical Statistics NIPH
Petrit Popova – Ministry of Economy & Finance, MSH Budget
Agim Krasniqi MEF
Sarah Horrigan USAID at MEF
Skender Syla; Tom Judd; Andre Issakov – World Health Organisation
Kaisa Rouvenin - Finnish Liaison Office
Peter Swinson – MSH Strategic Plan consultant
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Decan Municipality
Selmon Berisha
Decan QKMF
Maternity Unit
Haki Shehaj – Director
Staff
Xhemajl Latifaj – Finance
Laboratory staff: Gjyle Berisha; Rrustem Elezaj; Maliq Tishukaj
Dragash Municipality
Ramadan Jashari
Dragash MFMC
Raif Shala – Director
Mstan Sadiki – emergency dept
Shazi Bajrami – xray tech
Agim Dauti – biologist
Xhevahire Bojaxhiu - laboratory technician
Adile Kurtishi – Pharmacy technician
Ferizaj Municipality
Director Health & Social Services- Bashkim Hyseni
Ferizaj QKMF
Medical Director – Sevdije Bajraliu
Director – Ganimete Bajrami
Admin – Agim Rexhaj
Head Nurse – Dauti Derguti
Laboratory staff
Vaccination Unit staff
Radiology and pulmology staff
Maternity Unit
F Bojaxhiu – gynecologist
Badushe Bajraktari - midwife
Ferizaj Hospital
Director- Sylejman Metushi
Head of Nursing – Ymer Llabjani
Chief Dentist Afrim Abazi
Dentistry staff
Pharmacy staff
Chief Paediatrician
Obstetrics Department staff
Surgery Department staff
Emergency Department staff
Fushe Kosove Municipality
Director Health & SW – Nurije Avdiu
Fushove Kosove QKMF
Ali Prebreza
Nursing staff
Laboratory Technician
Family Medicine Specialist
Gjilan Municipality
Director Health & Social Welfare - Maxhide Shaqiri
Gjilan MFMC
Salihe Mustafa – Director
Head Nurse
Deputy Manager - Nexhat Halili
IT Department staff
Zejdush Tahiri – Head Emergency
Hajriz Shaqiri – Chief of Family Medicine
Pharmcy technicians: Selvete Mahmuti;
Adile Sylejmani
Gjilan Hospital
Director - Xhavit Hajdari
Zijadin Hasani – manager
Head Emergency dept
Head of Nursing – Sevdije Jashari Ramadani
Pediatrician
Laboratory staff
Emergency Department staff
Radiology staff
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Laboratory staff including Sebahate Hasani
Xhevdet Latifi – Pulmologist & Dialysis Unit staff
Gynaecologist & Maternity Department staff
Gjakova municipality
Kriste Deda – Director Health & Social Welfare
Gjakova MFMC
Yllzim Dyla – Director
Hektor Binishi – Family Medicine Dept Head
Head dentistry
Burim Gojani – councilor FM
Gjakova Hospital
Haxhi Kamberi – Director
Medical Director
Xhafer Xhiha
Drenac (Gllogoc) Municipality
Ilmi Dobra - Director H&SW
Drenas QKMF
Gani Halilaj – Dire ctor
Emergency Dept staff – Sheremet Hasi; Hysni Neziri
XRay technician – Daut Gjinovci
Lab staff incl Rexhep Kastrati; Qerkin Berisha;
Musa Shala
Pharmacy techs – Sherife Aliu; Arjana Gjinovci
Integrated House
Mirdita Leku; Sofa Hamza; Aferdita Krasniqi;
Xhavit Hamza
Maternity Unit
Gynecologist – Jakup Dobra
Midwives including Shpresa Ajazi
Gracinice Municipality
Gracinice Hospital
Paediatric surgeon – Dr. Dragan Peric
Hani Elezit Pilot Municipality
Director Health& SW – Sear Dernjani
Hani I Elezit QMF
Menduh Kaloshi
Isa Berisha
Medical and dental staff
Istog (Burim) Municipality
Januz Januzaj – Director Health & SW
Brahim Hetemi – health budget
Istog QKMF
Anton Gega – Director
Rifat Idrizaj – economoist
Sevdije Shabanaj – quality coordinator
Mexhide Ymeraj – head nurse
Sabrije Blakaj – lawyer
Ekrem Berisha – emergency department
Teuta Kukleci;Lule Berisha – emergency nurses
Shaban Bajraktari – XRay technician
Aferdita Xhuraj – Laboratory technician
Maternity Unit
Cele Aliaj - Gynecologist
Midwives
Junik Pilot Municipality
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Director Health&SW – Ali Kuqi
Junik QMF
Rexhe Gjocaj & Nursing staff
Kacanik Municipality
Director Health & SW – Misim Sopa
Kacanik QKMF
Maternity unit
Director - Nejazi Luma
staff including Filkizare Dema
Nezafete Avdiu
Isa Berisha
Emergency department staff including Dashurie Gashi
Dental department staff
Kamenica Municipality
Director H&SW – Nebi Sylejmani
Kamenica MFMC
Director – Rizah Hoda
Nafije Ajvazi – head nurse
Quality coord – Asllan Dermaku
Emergency dept staff
Internal medicine – Muhamet Dermaku
Epidemiologist – Njazi Hoda & Vacc nurse
Laboratory staff
Maternity Unit
Gynaecologist – Zeqir Gerbeshi
Midwife
Kline Municipality
Director Health & SW – Palush Prenaj
Kline QKMF
Director – Dr. Ali Ahmetxhekaj
Head Nurse
Pharmacy Technician
Emergency Department staff
Lipjan Municipality
Director H&SW – Banush Gashi
Lipjan QKMF
Director - Naim Avdiu
Maternity Unit
Staff
Malisheve Municipality
Skender Hoti – Director H&SW
Malisheve QKMF
Aziz Thaqi – Director
Shefqet Pacarizi – quality coordinator
Besnik Krasniqi – Emergency head tech
Hysen Mazreku; Besim Morina – XRay tech
Burim Thaqi – lab technician
Vezire Buqaj Mazreku – dentist
Maternity Unit
Abaz Morina – gynecologist
Rukije Shala - midwife
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Agim Morina – pharm tech
Mamushe QMF
Head Nurse – Zymryt Kala and nursing staff
Dentist
Mitrovice Municipality
Shaqir Demiri - Director Health & Social Welfare
Mitrovice QKMF
Sanije Meholli -Director
Family Medicine director
Chief dentist
Dental staff
Emergency Department staff
Mitrovice Hospital
Director – Drita Fazliu
Administration Director Head of Paediatrics Department
Gynecology Department staff
Emergency Department staff
Dialysis unit staff
Novo Berde Municipality
Director H&SW – Xhemail Novoberdaliu
Municipality Director- Bajrush Ymeri
Novo Berde MFMC
Director – Rrahim Veliu & staff
Obiliq (Kastriot) Municipality
Fatmir Berbatovci – Director
Dr Ymer Krasniqi – Chief of Health Sector
Mihane Mjekiqi – Chief of Social Welfare sector
Obliiq QKMF
Mentor Preniqi Director
Vjollca Hoti – chief FM dept
Rejhane Zhushi Musliu – HR
Mevlyde Restelica – head nurse
Zyrafete Shaljani – HIS
Fatmir Mena – emergency
Ibrahim Berisha – radiologist
Paediatrics staff including Shuqa Adeti; Violeta Husenaj
Peje municipality
Director Health & Soc Welfare – Xhafer Dema
Peje MFMC
Director - Islam Husaj
Kujtim Zajmi
Internal med –Edmond Haliti
Gynecologist – Jashar Lajci
Accounting – Arbresha
Main Technician - Dem Curri
Dental Department staff
IT Department staff
Peje hospital
CEO – Skender Dreshaj
Medical Director & Head of Prof council
Enver Muja
Shemsedin Muhaxheri
Admin services –Gani Mucolli
Head of Nursing
Laboratory Department staff
Emergency Department staff
Radiology Department staff
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Transfusion Department staff
Paediatrics Department staff
Besiane (Podujeve) Municipality
Dr Bahri Thaqi
Podujeve QKMF
Dr Ekrem Hyseni – Director
Xhabire Ibrahimi – dermat
Rifat Salihu – dep director
Burim Hasani – head technician
Maternity Unit
Staff
Prishtine Municipality
Director H&SW Rame Miftari (have card)
Pristine MFMC
Dep Director – Drita Peqani
Avdullah Hoti – Chief FM
Myrvete Sopi – Head Nurse
Lab- Besa Canhasi
XRay radiologist
XRay tech – Skender Begolli
Prishtine City Emergency Centre
Haki Dragusha
Agron Ruva
Staff
Ex-Public pharmacy
Pharmacist
Prishtine University Clinical Centre
Director QKUK - Jusuf Ulaj
Deputy Director - Afrim Blyta
Education Manager
Director ORL and staff
Ophthalmology staff
Director Gynecology and staff
Director Pediatrics and staff
Director Internal Medicine and staff
Surgery staff
Director Endocrinology and staff
Director Neonatal ICU and staff
Director Infectious disease & staff
Emergency Department staff
Pathology Institute staff
Director Neurology & staff
Director Psychiatry & staff
Dep Director Dermatovenerology & staff
Abdominal surgery clinic staff
Coronary Care unit staff
Dialysis unit staff
Gastroenterology staff
Director Plastic surgery & staff
Director Pulmology
University Clinical Centre of Dentistry
Director & staff
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Prizren Municipality
Blerime Oseku - Health Coordinator
Assistant/ accountant
Prizren QKMF
Director - Narqize Hoxhaj
Laboratory staff
Radiology staff
Emergency centre staff
Dental Department staff
Medical records staff
Prizen Regional Hospital – Prim Dr Daut Mustafa
Director - Myzafer Kalanderi
Head Pharmacy
Head Emergency - Sadri Hulaj
Emergency Department staff
Pharmacy staff
Laboratory staff
Radiology Department staff
Rahovec Municipality
Dir H&SW - Ejup Zeka
Rahovec MFMC
Director- Ibrahim Vuciterna
Quality coordinator – Qazim Cana
Head nurse – Bukurije Canta
Laboratory technician – Arjeta Kaja
XRay technician – Vahid Kadiri
Maternity Unit
Gynecologist – Shazije Vuciterna
Midwives including – Makfire Shtavica
Shtime Municipality
Director H&SW – Fatmir Emini
Chief of Health – Reshat Gashi
MFMC
Agim Zejna
Muse Baftiu – head tech
XRay dept staff: Osman Ismajli
Laboratory staff: Sevdije Imeri; Shaban Hetemi
Emergency dept staff: Emirjeta Bajrami; Ali Derguti;
Luljeta Selimaj
TB unit
Mehmet Alibegu
Integrated Mental Health Centre
Nursing staff
Skenderaj Municipality
Dr H&SW – Nazif Gogjuli (occupant med)
Skenderaj QKMF
Fazli Kadriu – gynaecologist
Emine Shabani
Ferat Kabashi – head technician
Hetem Musliu – paediatrician
Emergency room staff including Aferdita Rama
Laboratory technician – Ramiz Rama
Maternity dept
Midwives – Faza Gashi; Ajshe Mjekiqi
Strpce Municipality
Director Health & SW – Tefik Islami
Slavisa Vasiljevic – Chief Health Sector
Brod punkt & Drajkovc FMC
Director - Imer Murati
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Suhareke (Thendarhe) Municipality
Ardian Shala – Director H&SW
Salih Butyqi – Chief H&SW
Shehide Bytyqi – Budget & Finance
Suhareke QKMF
Maternity Unit
Hidajete Haliti – Family Medicine Specialist
Adem Halitaj – Gynecologist
Bukurije Berisha – pharmacy technician
Selim & Hidajete Berisha
Fatmire Bicaj – Family Medicine Specialist
Rrahim Elshani – radiology technician
Hylnaze Aliu; Xhevahire Gallapeni – vaccination unit
Sanije Bajraktari; Ganimete Kuci; Durak Obrazhda; Samir Ademi – laboratory technicians
Viti Municipality
Dir H&SW – Taip Alidema
Maternity Unit
Staff
Viti MFMC
Director – Nazim Dauti and staff
Vushtrri Municipality
Director Health & Social Services - Iliriana Nura
Budgeting officer
Vushtrri QKMF
Director - Safet Idrizi
Chief budgeting officer
Medical staff
Vaccine unit staff
Pharmacy staff
Vushtrri Hospital
Director – Vedat Mulaku
Head of Nursing
Obstetrician
Midwives
Internal Medicine Department staff
Surgery Department staff
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APPENDIX II. HEALTH CARE FACILITIES IN KOSOVO
1. Main Family Medicine Centres
Facility
QKMF Adem Ukehaxaj
QKMF Dragash
QKMF Ferizaj
QKMF Fushe Kosovo
QKMF Gjakova
QKMF Gjilan
QKMF Drenas
QKMF Istog
QKMF Kacanik
QKMF Kamenice
QKMF Kline
QKMF Lipjan
QKMF Malisheve
QKMF Mamushe
QKMF Mitrovica
DZ Mitrovice Nth
Municipality
Decan
Dragash
Ferizaj
Fushe Kosovo
Gjakova
Gjilan
Gllogovc (Drenas)
Istog
Kacanik
Kamenice
Kline
Lipjan
Malisheve
Mamushe
Mitrovica Sth
Mitrovice Nth
Facility
QKMF Novoberde
QKMF Obiliq
QKMF Peja + Emergency;
Mother & Child Centre
QKMF Podujeve
QKMF Prishtina +
Stomatologia
QKMF Prizren
QKMF Rahovec
QKMF Skenderaj
QKMF Shterpce
QKMF Shtime
QKMF Suhareka
QKMF Viti
QKMF Vushtrri
DZ Zubin Potoc
Zavod Zdravlja Za Zastitu
Municipality
Novoberde
Obiliq
Peja
Podujeve
Prishtina
Prizren
Rahovec
Skenderaj
Shterpce
Shtime
Suhareka
Viti
Vushtrri
Zubin Potoc
Zvecane
2. Family Medicine Centres
Facility
QMF Isniq
QMF Strellc
QMF Irzniq
QMF Krushev
QMF Llopshnik
QMF Rapqa
QMF #1
QMF #2
QMF Greme
DZ Kosovo Polje
QMF Maradi e Ulet
QMF Miradi e madhe
QMF rabovc Bardhi I ulet
QMF Sllatine e madhe
QMF Ujmir
DZ Ugljare
QMF Vragoli
Municipality
Decan
Decan
Decan
Dragash
Dragash
Dragash
Ferizaj
Ferizaj
Ferizaj
Fushe Kosovo
Fushe Kosovo
Fushe Kosovo
Fushe Kosovo
Fushe Kosovo
Fushe Kosovo
Fushe Kosovo
Fushe Kosovo
Facility
QMF #1
QMF #2
QMF #3
QMF Brogova
QMF Cermjan
QMF Dardani
QMF Ereniku
QMF Orize
QMF Ponoshec
QMF Skivjan
QMF 28.11 #2
QMF Arberi #5
QMF Bresalc
QMF Cernice
QMF Dheu I bardhe #4
QMF Kuvc e Ep
QMF Malisheve
Municipality
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Report 2: Data ______________________________________________________________________________________ 108
____________________________________________________________________________ Kosovo Health Master Plan
Facility
QMF Miresh
QMF Perlepnice
QMF Pograghe
QMF Ramiz cernica #6
QMF Ranilug
QMF Zhegra
DZ Centar
QMFDardani #3
QMF Kuvc e Ep
QMFPasjane
QMF Baice (Rezistence)
QMF Gilaneselle (Shkabe)
QMF Komoran (Bushat)
QMF Orliat (Arllat)
QMF Terstenik (Qendrese)
QMF Hani I Elezit FHC
QMF Gurakoc
QMF Rakosh
QMF Vrell
QMF Junik
QMF Gracanica
QMF Kacanik te vjeter
QMF Hogosht
DZ Kamenice
QMF Rogoqice
QMF Sjerk
QMF Ujmir
QMF Zllakuqan
DZ Leposavic
DZ Donja Gusterica
QMF Gadime
QMF Janjeve
QMF Magure
QMF Shale
QMF Kiev
QMF Shipol
QMF Ilirida
QMF Tuneli I pare
QMF Shupkofc
QMF Sheshi I vjeter
QMF Jasenoivik
QMF Prekovc
QMF Tuller
Municipality
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan (or
Kamenice?)
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gllogovc (Drenas)
Gllogovc (Drenas)
Gllogovc (Drenas)
Gllogovc (Drenas)
Gllogovc (Drenas)
Hani I Elezit
Istog
Istog
Istog
Junik
Gracanica
Kacanik
Kamenice
Kamenica
Kamenice
Kline
Kline
Kline
Leposavic
Lipjan
Lipjan
Lipjan
Lipjan
Lipjan
Malisheve
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Novoberde
Novoberde
Novoberde
Facility
QMF Mllosheve
QMF Plemetin
QMF #1
QMF Vitoramic
QMF #3
QMF #4
QMF #2
QMF #5
QMF Zahaq
QMF Radavc
QMF Lluzhan
QMF Kerpimeh
QMF Podujeva 2
QMF Gllamnik
QMF Bradash
QMFBajqin
QMF Orllan
QMF Majac
QMF Pollat
QMFBatllav
QMFHalabak
QMF Sfecel
QMF Shajkovc
QMF Llapashtic
QMF Besi
QMF #1
QMF #2
QMF #3
QMF #4
QMF #5
QMF #6
QMF Hajvali
QMF keqekoll
QMF Kishnice
QMF llukar
QMF Matiqan
QMF Mramor
QMF Rimanisht
QMF Shkabaj
QMF Sliviv
QMF #1
QMF Gjonaj
QMF Hoqe e qytetit
Municipality
Obiliq
Obiliq
Peja
Peja
Peja
Peja
Peja
Peja
Peja
Peja
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prizren
Prizren
Prizren
Report 2: Data ______________________________________________________________________________________ 109
____________________________________________________________________________ Kosovo Health Master Plan
QMF Korishe
Facility
QMF Lakuriq
QMF Pirane
QMF Ralin
QMF Reqan
QMF Romaje
QMF Zhur
QMF Fortes
QMF Krusha e Madhe
QMF Qifllak
QMF Ratkoc
QMF Likoc
QMF Prekaz I eperm
QMF Qirez
QMF Runik
QMF Turiqec
QMF Drajkovc
Prizren
Municipality
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Rahovec
Rahovec
Rahovec
Rahovec
Skenderaj
Skenderaj
Skenderaj
Skenderaj
Skenderaj
Shterpce
Facility
QMF Muzeqine
QMF Gjinoc
QMF Mushtischt
QMF Studencan
DZ Kllokot
QMF Pozheran
QMF Sadovin
QMF Sllatin
QMF Smir
QMF Verbovc
QMF Novolan
DZ Priluzje
QMF Pantine
QMF Lumi Bardh
QMF Maxhunaj
QMF Smrekonice
Municipality
Shtime
Suhareka
Suhareka
Suhareka
Kllokot /Viti
Viti
Viti
Viti
Viti
Viti
Vushtrri
Vushtrri
Vushtrri
Vushtrri
Vushtrri
Vushtrri
3. Punkt/Ambulancas
Facility
Pobergj
Lumbardh
Gramaqel
Prapaqan
Prelep
Ratsih
Kosav
Bellobrad
Bresan
Blaq
Brod
Kuke
Radesh
Restelic
Vraniq
Bablak
Babushi
Dardani
Gacke
Greme
Jezerce
Komogllave
Municipality
Decan
Decan
Decan
Decan
Decan
Decan
Dragash
Dragash
Dragash
Dragash
Dragash
Dragash
Dragash
Dragash
Dragash
Ferizaj
Ferizaj
Ferizaj
Ferizaj
Ferizaj
Ferizaj
Ferizaj
Facility
Mirash
Neodime
Softaj
Talinivci
Bardh I madh
Fushe Kovovo
Kozmin
Punkti ashkali
Bec
Brekoc
Danjan
Doblibare
Dol
Gergoc
Guska
Korenice
Kralan
Lipovec
Moliq
Novoselle
Sheremet
Shqiponja
Municipality
Ferizaj
Ferizaj
Ferizaj
Ferizaj
Fushe Kosovo
Fushe Kovovo
Fushe Kosovo
Fushe Kosovo
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Gjakova
Report 2: Data ______________________________________________________________________________________ 110
____________________________________________________________________________ Kosovo Health Master Plan
Facility
Vishtazhin
Budriga
Kishna pole
Kisha e Qytetit
Koretistu
Kuscu
Livoq I eperm
Livoq I poshtem
Llashtice
Makresh
Parallove
Shilovo
Shurdhan
Straze
Uglar
Verbic e zhegovcit
Abri e Eperme
Dobroshefc (Dritan)
Gradice (Dodone)
Terdec (Grykas)
Nekofc (Nikaj)
Stankofc (Flamuras)
Vasileve (Paklek/Malesi)
Gorance
Banje
Cerkole
Dobrush
Dubrav
Kaliqan
Osojan
Saradra
Studenic
Veriq
Zaliq
Doganaj
Begrace
Bicaj
Gure Zi
Lisnaje
Lum Bardhe
Qafe Shqipe
Stagove
Ajnovc
Municipality
Gjakova
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gllogovc (Drenas)
Gllogovc (Drenas)
Gllogovc (Drenas)
Gllogovc (Drenas)
Gllogovc (Drenas)
Gllogovc (Drenas)
Hani I Elezit
Istog
Istog
Istog
Istog
Istog
Istog
Istog
Istog
Istog
Istog
Kacanik
Kacanik
Kacanik
Kacanik
Kacanik
Kacanik
Kacanik
Kacanik
Kamenice
Bosce
Facility
Bozhevc
Bushince
Busavate
Desivojce
Domarovc
Karaqeve
Kolloleq
Kopernice
Koretine
Korminjan
Krileve
Lisocke
Muqiverce
Rajanov
Ropotove
Shipashnice e Eperme
Strezovc
Topanice
Tugjec
Budisallc
Cerovik
Drenoc
Gllareve
Grabanic
Jagod
Jashanic
Jashanic
Shtupel
Babushe
Banulle
Dobraje
Dobratin
Gushterice
Kraishe
Lepi
Livagje
Rubovc
Sllovije
Bellanic
Ceralluk
Dragobil
Drenoc
Fshati I ri
Kamenice
Municipality
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kline
Kline
Kline
Kline
Kline
Kline
Kline
Kline
Kline
Lipjan
Lipjan
Lipjan
Lipjan
Lipjan
Lipjan
Lipjan
Lipjan
Lipjan
Lipjan
Malisheve
Malisheve
Malisheve
Malisheve
Malisheve
Report 2: Data ______________________________________________________________________________________ 111
____________________________________________________________________________ Kosovo Health Master Plan
Facility
Kavaqari
Lozic
Lumizad
Pagurush
Panoc
Terpez
Bare
Bair
QMF Koshtove
Kciq
Guchafc
Fidanishte
Caber
Kodra e Minatoreve
Rashan
Zhazhe
Broboniq
Vilahi
Bajgore
Kaqanoll
Selac
Zabergje
Bistrice
Llabjan
Breznice
Palaj
Shipitull
Siboc
Raushiq
Loxhe
Baran
Leshan
Poqeste
Trestenik
Ozrim
Trebovi
Doberdo
Cryshec
Kryshec
Gllogjan
Gorazdevac
Novosell
Tenic
Municipality
Malisheve
Malisheve
Malisheve
Malisheve
Malisheve
Malisheve
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Mitrovica
Novoberde
Obiliq
Obiliq
Obiliq
Obiliq
Peja
Peja
Peja
Peja
Peja
Peja
Peja
Peja
Peja
Peja
Peja
Peja
Peje
Peja
Peja
Drelaj
Peja
Facility
Gorazhd
Haxaj
Dumnic
Dobratin
Dyz
Murgull
Lupc i poshtem
Livadic (Livadhishte
Hertice
Bardhosh
Barilev
Bullaj
Flotacion
Koliq
Shashkovc
Viti
Arbane
Dardani
Granqoar
Jabllanice
Kushmine I Hasit
Libeqeve
Lubinje e poshtme
Lubishte e Prizrenit
Lubna e eperme
Lugishte Has
Manastirice
Mushnikove
Nashec
Planej
Skorobishte
Strugje
Veleshe
Vllashnje
Zym Has
Drenoc
Hoxha e madhe
Lagja veriore Rahovec
Velika Hoca
Brezovica
Cevce
Gornja Ditnja
Viga
Municipality
Peja
Peja
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Podujeve
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prishtina
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Prizren
Rahovec
Rahovec
Rahovec
Rahovec
Shterpce
Shterpce
Shterpce
Shterpce
Report 2: Data ______________________________________________________________________________________ 112
____________________________________________________________________________ Kosovo Health Master Plan
Facility
Petrove
Pjetershtice
Aqareve
Izbice
Kline e eperme
Kllodernice
Llaushe
Polac
Qubrel
Rezall
Bukosh
Duhel
Drejkoc
Mohlan
Nishor
Samdregje
Sopi
Municipality
Shtime
Shtime
Skenderaj
Skenderaj
Skenderaj
Skenderaj
Skenderaj
Skenderaj
Skenderaj
Skenderaj
Suhareka
Suhareka
Suhareka
Suhareka
Suhareka
Suhareka
Suhareka
Facility
Begunc
Debelldeh
Gjylekar
Letnic
Remnik
Stubell
Terpez
Verbovac
Zhiti
Dumnice
Druar
Dubofc
Samadrexhe
Ashlan
Strofc
Ceceli
Municipality
Viti
Viti
Viti
Viti
Viti
Viti
Viti
Viti
Viti
Vushtrri
Vushtrri
Vushtrri
Vushtrri
Vushtrri
Vushtrri
Vushtrri
4. Secondary and Tertiary Care Facilities
Facility
Municipality
Ferizaj Regional Hospital
Ferizaj
Gjakova Regional Hospital
Gjakova
Gjilan Regional Hospital
Hirurska I Genkoloska Bolnica
Interna Bolnica
Bolnica
Gjilan
Mitrovice Regional Hospital
Gracinice
Laplje Selo
Mitrovica Nth
Mitrovice Sth
Peja Regional Hospital
Peja
Prishtine University Clinical Center
Prishtine
Prizren Regional Hospital
Prizren
Vushtrri Regional Hospital
Vushtrri
Report 2: Data ______________________________________________________________________________________ 113
____________________________________________________________________________ Kosovo Health Master Plan
5. Facilities in parallel Serbian Primary Health Care System
Facility
Babush
Bablak
Talinovc
DZ Kosovo Polje
DZ Ugljare
Fushe Kovovo
DZ Centar
QMF Kuvc e Ep
QMFPasjane
QMF Ranilug
Budriga
Kisha e Qytetit
Koretistu
Kuscu
Makresh
Parallove
Ponesh
DZ Partesh
Shilovo
Straze
QMF Gracanica
Osojane
QMF Kamenice
AMF Ajnovc
AMF Bosce
AMF Bozhevc
AMF Bushince
AMF Domarovc
AMF Kolloleq
AMF Korminjan
AMF Rajanov
Municipality
Ferizaj
Ferizaj
Ferizaj
Fushe Kosovo
Fushe Kosovo
Fushe Kovovo
Gjilan
Gjilan
Gjilan
Gjilan (or Kamenice?)
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Gjilan
Partesh/Gjilan
Gjilan
Gjilan
Gracanica
Istog
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Kamenice
Ropotove
DZ Leposavic
DZ Donja Gusterica
Dobratin
Gushterice
Lepi
Livagje
Rubovc
DZ Kllokot
DZ Mitrovice Nth
Prekovc
QMF Plemetin
Babin Most
Gorazdevac
Livadhiste
AMF Velika Hoca
QMF Drajkovc
QKMF Shterpce
Brezovica
Cevce
Gornja Ditnja
Viga
Verbovac
DZ Priluzje
Banjska
Grace
Gojbulje
Zavod Zdravlja Za Zastitu
DZ Zubin Potoc
Komenjanu
Brekovcu
Kamenice
Leposavic
Lipjan
Lipjan
Lipjan
Lipjan
Lipjan
Lipjan
Kllokot /Viti
Mitrovice Nth
Novoberde
Obiliq
Obiliq
Peje
Podujeve
Rahovec
Shterpce
Shterpce
Shterpce
Shterpce
Shterpce
Shterpce
Viti
Vushtrri
Vushtrri
Vushtrri
Vushtrri
Zvecane
Zubin Potoc
Gjakova?
6. Parallel Serbian Secondary Care Facilities
Facility
Hirurska i Genkoloska Bolnica
Interna Bolnica
Bolnica
Municipality
Gracinice
Laplje Selo
Mitrovica
Report 2: Data ______________________________________________________________________________________ 114