In-depth | Elections2021

2021 Elections: A different perspective on our health

By - 08.02.2021

With elections happening almost every two years, K2.0 listens to ideas on solutions amid dubious promises.

Although elections have become a common occurrence in Kosovo, discussing what is genuinely important for the lives of constituents is rare.

In political party rallies, televised debates and what is written and said by and about political parties, there is a lot of talk on party calculations and maneuvers, polls, slogans and individuals; and less about practical issues that would basically inform voters of what to expect after the electoral campaigns. In principle, the electoral campaigns themselves should serve this purpose — so that voters know what they are voting for.

Amid all of this and, above all, to challenge this context, we at K2.0 spoke with experts in various fields. Through their answers we have endeavored to list some of the issues that are not discussed but will be important for voters when they head to the polls on February 14.

Through the series “Elections 2021, a different perspective” that comprises eight articles, each focused on one specific field, we elaborate on what exactly is not receiving due attention, what is the current situation and what should be done to change things in favor of the citizens. We also try to inform voters and make their well-being the focus of discussion by providing forward looking solutions.

A different perspective on our physical wellbeing

We will start with a sphere that at least for now needs to be addressed with greater urgency than the others: Health.

Because successive governing institutions have not put the health of Kosovo citizens first, many cracks in the health system over the last two decades have been deepening rather than repairing.

After so many years filled equally with as many promises as disappointments, it was the Covid-19 pandemic that ultimately managed to bring public health into the spotlight.

But plans to “cure” health, however, remain lacking.

In these elections, not only Vetëvendosje, but also LDK and PDK are focusing on health insurance and a health information system as the two primary issues that need to be addressed. Each of the parties treats them as priorities, but none of them has presented concrete implementation plans, and the deadlines they mention vary from the first year of government to the end of the mandate. What they have in common is that these reform plans are recycled from recent elections, and even earlier ones, because so far they have not been implemented.

When it comes to protecting the health of citizens from COVID-19, there is not so much room for maneuvering given Kosovo’s peripheral position in global efforts to vaccinate citizens.

LDK, the leader of the current governing coalition, aims to vaccinate about 75% of the population — a “significant number” of them by June — with vaccines that are supposed to arrive in February. Vetëvendosje has said that it aims to vaccinate up to 60% of the population by the end of the year, and PDK has pulled back the deadline by the end of the summer for 70% of the population. While AAK has surpassed all three, making plans to vaccinate all citizens within a period of three months.

Regarding COVID-19 and more, we spoke with three experts in the field of health and social welfare, including Hana Xhemajli, a global health policy researcher; Bujar Vitija, editor-in-chief of Gazetës Shneta, which covers health; and Artan Mustafa, researcher and lecturer on social policy. To our questions about what we lack, what aspirations we should have and how change could come about, the experts answered:

What do we lack?

Hana Xhemajli, health policy researcher:

Being the sort of a system where we only react when a crisis happens and we do not take the time and effort with proper preventive measures, can have detrimental effects on the health of the population — and not only when we are fighting a pandemic.

What we urgently need is a government that understands that health care issues aren’t just a health issue. They touch upon every aspect of the lives and welfare of people, as we’ve seen with the effect of Covid-19. 

Bujar Vitija, editor- in-chief, Gazetës Shneta (The Health Gazette): 

Kosovo is one of the few countries that does not have a health information system. As a result, we do not have any correct data about illnesses in Kosovo, the number of people who suffer from them and the mortality rates. We cannot build a strategic health system if we do not have information from the field regarding the illnesses that endanger our citizens, which fields we should be investing in further and what the best solutions are.

To continue further, we need health insurance. In Kosovo, the best health insurance model would be that of the Bismarck [fund], where the employee and employer pay a percentage from the salary to the Fund. There are some other steps that would need to be taken before insurance is implemented, such as the price list, treatment protocols, e-prescriptions, etc.

"Hospitals do not have a central oxygen network and patients are treated with canisters."

However, all these shortcomings have also contributed to the poor management of the pandemic that has occurred in Kosovo. We have not had specializations for about five years in Kosovo, consequently we are behind with a generation of doctors. The pandemic brought to the surface the small number of anesthesiologists and other medical staff. [It also highlighted] the lack of respirators, with Kosovo having the lowest amount per capita in the region and Europe. Hospitals do not have a central oxygen network and patients are treated with canisters. There is a lack of adequate space for the treatment of infectious diseases, etc.

Artan Mustafa, researcher and lecturer of social policy:

One of the biggest shortcomings in the entire social protection sector remains the lack of a functional and efficient public health insurance. The state today spends on public health care and medicines from the essential national list, but in the absence of formal insurance, Kosovo — implicitly — resembles the model of “state insurance” applied in countries like Russia and not in the region and the EU. This model is characterized by numerous ambiguities in terms of access to services and medicines, inequalities created by the influence of different bureaucratic and interest groups, as well as generally by poorer health protection for the most fragile social categories.

"The National Institute of Public Health of Kosovo, for example, does not have a publicly accessible database of surveys it conducts."

The data and research clearly suggest that in Kosovo there are very large disparities in health expenditures among the population, in terms of care and medical expenditures. Only a narrower, generally richer, section of society possesses health insurance in the private market and is more protected in cases where the need for health expenditures arises. Public insurance would have very positive returns in increasing the quality of life and health in Kosovo — something that has been consistently sacrificed in favor of budgetary discipline.

Another obvious shortcoming is the lack of detailed information and data that should be issued regularly by hospitals and the National Institute of Public Health of Kosovo (NIPHK). The NIPHK, for example, does not have a publicly accessible database of surveys it conducts (on the public dime), which would enable the public and researchers everywhere to analyze and understand much better the state of health in the country. These shortcomings come mainly from the fact that no responsibility has been demanded from the highest state levels.

What objectives should guide us?

Bujar: We must aspire to have a patient-centered health system. Today we have a bureaucratic health system, there is no accountability and responsibility, management is poor and corruption and abuse are at very high levels.
Unfortunately, today Kosovar patients are virtually neglected in the public health system, ripped off by private hospitals, and have no hope of recovery. A health care system that is not intended for the patient, but only as a means to enrich certain people, can never be improved.

Artan: When it comes to domestic policy, I think that over the next 10 years Kosovo needs to work toward achieving a more balanced social contract.

"If there were one term that would define the history of Kosovo in the last 100 years, it would be 'inequality.'"

An important part of this social contract should be the extension of public care for preschool children. This can start with the extension of current preparatory classes for 5-6 year olds from 2.5 hours to 5-6 hours per day and then continue with the expansion of the public inclusion of younger age groups. A large part of today’s schools can expand their activity toward preschool care.

If there were one term that would define the history of Kosovo in the last 100 years, it would be “inequality.” With today’s approach to child care, where the state intervenes extremely minimally with public care and expects care to be provided primarily by the market, Kosovo is working to consolidate inequality for many decades to come. On the contrary, a more ambitious public care policy for children would contribute to the personal development of children, the future labor market, the creation of more space for women to work, and the alleviation of large inequalities for the most fragile categories, etc.

Hana: I mention political will as an important step mainly because it is of utmost importance that Kosovo becomes a member of the World Health Organization (WHO). And as such I believe that the Sustainable Development Goals (SDGs) are one of the most important aspirations, which entails a wide variety of a “to-do” list in order to promote health and well-being. 

Within the “Good health and well-being” target, there are 13 sub targets that countries worldwide should focus on pre and post pandemic, with adjustments being made as seen fit in the current COVID-19 climate. Targets spanning from the reduction of the global maternal mortality ratio, to ending preventable deaths of newborns and children under 5 years of age and reduction of premature mortality from noncommunicable diseases through prevention and treatment and promote mental health and well-being. 

How can we achieve change?

Bujar: Regardless of who constitutes it, the new government should certainly prioritize the pandemic, providing vaccines and medicines and other materials needed for medical staff.

But in a more normalized situation, modernization and digitalization of public hospitals is needed to facilitate the work of medical staff. This would also increase the level of responsibility and accountability, as well as improve services for patients.

Primary health care should have better monitoring of patients in family health institutions through regular visits. Kosovo has so far invested the most in tackling health problems, but has never invested in preventing them.

Our health system creates patients rather than preventing them from becoming such. Therefore to advance in quality health services and have a healthy society, we need to have an accurate strategy that would start and end with the patient.

Artan: Empirical studies show that major changes in public policy in parliamentary systems have come with changes in the balance of power, coalitions. It remains to be seen whether a coalition can be formed that articulates public policy reforms and can push them forward in the country’s parliament. However, the same studies show that in fact, states and societies are often more likely to maintain continuity. In Kosovo, most political parties articulate the status quo in public policy; social science research remains poor, most media outlets have embraced the model of public entertainment rather than information, and there have long been no significant social movements. All of these are preconditions that suggest that we are more likely to see continuity rather than substantial change.

"We need the right people in the right positions of power to make any real changes possible."

Hana: For any major changes in a system that has had its road paved in corruption and lack of investment, change in its leadership is a must. We need the right people in the right positions of power to make any real changes possible. Becoming a member of any large organization requires knowledge and skill, and mostly momentum that so far have been lacking and we might have missed the opportunity completely for a while to see any real change. The new election, which is days away, promises to me a change, and change is what we need. Let’s hope it’s in the right direction.K

Feature image: Atdhe Mulla / K2.0.