strengthening center for prevention in primary health care center “zemun”

STRENGTHENING CENTER STRENGTHENING CENTER FOR PREVENTION IN FOR PREVENTION IN

PRIMARY HEALTH CARE PRIMARY HEALTH CARE CENTER “ZEMUN”CENTER “ZEMUN”

Dr Olivera M. ĆIRKOVIĆDr Olivera M. ĆIRKOVIĆProf. dr Milica ProstranProf. dr Milica Prostran

Dr Mladen JecmenicaDr Mladen JecmenicaDr Gordana MarkovicDr Gordana Markovic

May 14, 2009. CopenhaMay 14, 2009. Copenhagengen

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Republic of SerbiaRepublic of Serbia – Demographic – Demographic profileprofile

Area: 88,361 km2 Population: 7,498,001 (Census

2002) Administrative structure:

24 districts 160 municipalities

Aging: 17.2% are older than 65 years (2005)

Life expectancy at birth: 70 m, 75.4 f (2005)

Literacy Rate: 96.6% Unemployment: 31.79 % (2004) GDP: US$ 2,300 per capita

(2005) Health Expenditure: US$ 260

(2005), 7.6% GDP Below poverty line: 10.6%

(2003) – US$ 2.4 per day Crude death rate : 14.3 (2005)


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Background informationBackground information Leading causes of death in Serbia are Leading causes of death in Serbia are

practically identical to leading causes of practically identical to leading causes of death in developed (industrial) countriesdeath in developed (industrial) countries[1][1]

The highest burden of diseases in our The highest burden of diseases in our country is attributed to non-communicable country is attributed to non-communicable diseases (NCDs).diseases (NCDs).

Until now, health service in Serbia was not Until now, health service in Serbia was not effective in addressing the problem effective in addressing the problem [[1]1] Atanaskovic-Markovic Z, Bjegovic V, Jankovic S, Kocev N, Laaser U, Atanaskovic-Markovic Z, Bjegovic V, Jankovic S, Kocev N, Laaser U, Marinkovic J, Markovic-Denic Lj, Pejin-Stokic Lj, Penev G, Stanisavljevic D, Marinkovic J, Markovic-Denic Lj, Pejin-Stokic Lj, Penev G, Stanisavljevic D, Šantric-Milicevic M, Šaulic A, Šipetic-Grujicic S, Terzic-Supic Z, Vlajinac H.Šantric-Milicevic M, Šaulic A, Šipetic-Grujicic S, Terzic-Supic Z, Vlajinac H. The Burden of Disease and Injury in SerbiaThe Burden of Disease and Injury in Serbia. Belgrade: Ministry of Health of . Belgrade: Ministry of Health of the Republic of Serbia, Belgrade; 2003.the Republic of Serbia, Belgrade; 2003.


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Background informationBackground information Cardio-vascular diseases and malignant Cardio-vascular diseases and malignant

tumours contribute to more than three tumours contribute to more than three quarters of all causes of death in 2005quarters of all causes of death in 2005

More than half of deaths in Serbia (56.8%) More than half of deaths in Serbia (56.8%) were deaths due to cardio-vascular diseaseswere deaths due to cardio-vascular diseases

Almost every 5th death (18.5%) was a Almost every 5th death (18.5%) was a malignant tumour victimmalignant tumour victim

Injuries and intoxications were responsible Injuries and intoxications were responsible for additional 3.6% of deaths in Serbiafor additional 3.6% of deaths in Serbia

2.7% were due to COPD (chronic obstructive 2.7% were due to COPD (chronic obstructive pulmonary diseases), and complications of pulmonary diseases), and complications of diabetes account for 2.4% of deathsdiabetes account for 2.4% of deaths


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40,00

60,00

80,00

100,00

120,00

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

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Stop

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All causes

NCD

CancerSymptoms and nondefined causesInjuriesCommunicable diseases


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Priorities for the next Bi-Priorities for the next Bi-Annual period have covered:Annual period have covered:

prevention of mass chronic non-communicable prevention of mass chronic non-communicable diseases and risk factors for their appearancediseases and risk factors for their appearance

development and planning of human resources for development and planning of human resources for health,health,

health system development directed towards health system development directed towards inequalities in healthinequalities in health

constant improvement of the health protection constant improvement of the health protection qualityquality

development of health information systems and development of health information systems and introduction of new models of financingintroduction of new models of financing

as well as strengthening country capacities for as well as strengthening country capacities for timely response to different dangers for public timely response to different dangers for public healthhealth


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Epidemiological study showed that Epidemiological study showed that the CRC incidence in Serbia is the CRC incidence in Serbia is around 45/100,000 inhabitants, around 45/100,000 inhabitants, thus the incidence in Serbia is very thus the incidence in Serbia is very close to the one existing in the close to the one existing in the developed European countriesdeveloped European countries [Krivokapic Z. Consensus conference, diagnostics and [Krivokapic Z. Consensus conference, diagnostics and treatment of colorectal cancer. Belgrade 2002: 44-54) treatment of colorectal cancer. Belgrade 2002: 44-54)


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Breast cancer is the most frequent Breast cancer is the most frequent malignant tumor among womenmalignant tumor among women

There are 4000 newly registered There are 4000 newly registered cases a year, which represents more cases a year, which represents more than a quarter of all malignant than a quarter of all malignant illnesses among womenillnesses among women

1600 women die of breast cancer 1600 women die of breast cancer annually, which makes up for around annually, which makes up for around 18% of the mortality rate caused by 18% of the mortality rate caused by cancercancer (Source-Project proposal “Preparation of the (Source-Project proposal “Preparation of the programme and implementation of prevention, early detection programme and implementation of prevention, early detection and treatment of malignant breast cancer,” Project of the Institute and treatment of malignant breast cancer,” Project of the Institute for Oncology and Radiology of Serbia)for Oncology and Radiology of Serbia)


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According to the WHO data, our According to the WHO data, our country has the highest incidence country has the highest incidence of cervical cancer in Europe. of cervical cancer in Europe. According to the 2002 data the According to the 2002 data the standardized cervical cancer rate standardized cervical cancer rate in Central Serbia was 27.2 per in Central Serbia was 27.2 per 100,000 women. 100,000 women. (Source – Cancer Register of the Republic of Serbia, without (Source – Cancer Register of the Republic of Serbia, without the data for AP Kosovo and Metohija)the data for AP Kosovo and Metohija)


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Objectives:Objectives: Center for Prevention as a new Center for Prevention as a new

department within primary department within primary health care centers has a role to health care centers has a role to coocoorrdinate and conduct dinate and conduct preventive activities on local preventive activities on local level as well as to develope level as well as to develope cooperation with partners in a cooperation with partners in a communitycommunity


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Establishment of a modern public Establishment of a modern public health services, based on the rule health services, based on the rule of equity of equity

Rehabilitation and modernization Rehabilitation and modernization of the existing health services in of the existing health services in PHCCPHCC

Fighting poverty and improving Fighting poverty and improving health and social conditions for health and social conditions for the most vulnerable groupsthe most vulnerable groups


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Center for prevention in Zemun Center for prevention in Zemun was establish in 2006, but just was establish in 2006, but just since end of 2007 started with since end of 2007 started with everyday work in deffferent everyday work in deffferent fieldsfields


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Results:Results: 4 subunits fuly 4 subunits fuly

developeddeveloped Preventive CenterPreventive Center

Unit for Education

And Coordination

Counseling Unit Mobile Unit Open line


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Results:Results: More then 3000 visits More then 3000 visits School „Quit smoking“ (27 patients)School „Quit smoking“ (27 patients) Screening carcinoma mammae Screening carcinoma mammae

passed 440 patientspassed 440 patients 12 workshop themes chosen by 12 workshop themes chosen by

patientspatients 3 carcinoma screening programs3 carcinoma screening programs 12 „Health Market“ events 12 „Health Market“ events


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Tasks for the futureTasks for the future To create long term, strong partnerships To create long term, strong partnerships

between local governments, governmental between local governments, governmental institutions and non-governmental institutions and non-governmental organisations organisations

Finding new ways to reach our vulnerable Finding new ways to reach our vulnerable citizens in the community with essential citizens in the community with essential services provided through Centers for services provided through Centers for preventionprevention

Introducing the concept of Introducing the concept of community based community based Centers for prevention that serve population Centers for prevention that serve population with limited access to health care with limited access to health care to other to other municipalities or region where those three municipalities or region where those three sectors involvement is not normally consideredsectors involvement is not normally considered


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ConclusionConclusion This unit has shown as extremely This unit has shown as extremely

important important way to reach way to reach vulnerable citizens and should vulnerable citizens and should be develop as high prioritybe develop as high priority


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[email protected]@yahoo.com

strengthening center for prevention in primary health care center “zemun”

Documents

leading causes of death

daycrude death rate

health service

health expenditure

ministry of health

half of deaths

noncommunicable diseases

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