Integrating Care in Kosovo: challenges for Primary Health Care

Background & Aim : In addition topoorquality of health services and the lack of appropriate responses to client demands in Kosovo, services are not well integrated and inter-sectoral collaboration between health, social welfare, education, and civil society, is limited. The Accessible Quality Healthcare (AQH) project in Kosovo funded by the Swiss Agency for Development and Cooperation aims to improve health of the Kosovar population through strengthening healthcare providers and managers to meet the needs of the patients (especially vulnerable groups), and making patients more aware of their rights and needs. The AQH project commissioned a study to identify and analyse the factors in health and other sectors that effect delivery of integrated Primary Health Care (PHC) services, and to better understand the challenges for integrated care services in Kosovo. Method : The study is a cross-sectional and multi-site, utilizing adapted qualitative approaches (in depth interviews with the key informants) that facilitate the collection of locally relevant data from the perspective of local stakeholders. Results : The current health care reform agenda in Kosovo provides several opportunities and constraints. The newly established Health Insurance Fund provides an opportunity to discuss cross sectorial integration of social and health services, however the Ministry of Health’s dual role in both developing and implementing policy sometimes creates confusion and policy implementation is often slow. Planning processes between health and other sectors is fragmented and continued conflicts of interest with the private sector pose a threat to any initiatives to bring about improvement to the public sector. Whilst current legislation does not prohibit the delivery of the integrated care it does not actively encourage it. The decentralization of PHC services to the municipality level has provided opportunities for better integration, but also in itself presents a challenge which has not yet been fully addressed as there is no uniform approach among municipalities. Conclusion : Whilst there are challenges to the integration of care in Kosovo there are also sources of motivation such as the health insurance reform that is currently under way and the fact that PHC services are already decentralised to the municipality level, providing opportunity for better coordination of service delivery at the local level. Other factors such as growing dissatisfaction with public services and the need for efficient spending of scarce resources could also encourage steps the right direction towards developing integrated care system in Kosovo.