Зміни стану здоров’я населення та надання медичної допомоги на первинному рівні

Abstract

Первинний рівень надання медичної допомоги є важливою ланкою у збереженні здоров’я населення у всіх країнах світу. Оптимізація даної системи була основною темою Всесвітньої Організації Охорони Здоров’я на конгресі в Алма-Ата у 1978 році, де були прийняті основні принципи та напрямки щодо оптимізації надання медичної допомоги на даному рівні, і сформульовані у вигляді міжнародної декларації, діючої до сьогоднішнього дня. В статті наведені результати аналізу власних досліджень щодо змін у системі охорони здоров’я, що стосуються первинної ланки надання медичної допомоги, та зміни стану здоров’я населення у 10 країнах пострадянського про- стору. Ключові слова: стан здоров’я населення, первинний рівень надання медичної допомоги, Центральна та Східна Єв- ропа

Primary care as an important tool to improve global health was recognized in many countries a few decades ago. It was a main topic of a WHO promoted conference resulted in the Declaration of Alma Ata, in 1978 where its importance was emphasized. This study aims to present an overview how the targets of this Declaration regarding primary care were realised in ten countries of the former Soviet block that joined the European Union since 2004. Some demographic, socio-economic, mortality based statistical dates were presented and scientific publications from respective countries were analyzed, personal experiences of family physicians of these countries were compared. After the collapse of communist regimes democratic political changes and health reforms started in these countries. There was an economic recession and decline in the first decade. Life expectancies improved and total health expenditures increased, in different extent by countries, although governments spent barely more for health care. Primary care providers are the main private sector contributors. Hospital based structure has changed, while number of outpatients contact is nearly the same. The ratio between secondary care specialists and family physicians remained too high and there is a shortage of educated nurses. Although new funding systems for primary care services were introduced, budgets were mostly redistributed without substantial increase and improve of outcome. The achievements of reform have rarely been evaluated systematically. There is no teamwork, praxis communities do not exist. Old style of polyclinics still predominates in some countries. The gate keeping system is more often symbolic or dysfunctional. Health promotion and preventive services are rarely supported by governments. Implementation of family medicine is not an absolute priority for decision makers. Political situation is often unstable. Despite the non-negligible achievements, the health systems in this part of Europe are still in the midst of transition. Key words: Alma Ata Declaration, Central and Eastern Europe, healthy system, primary care