State Policy on Health Care SERVICES IN Belarus

Organization and management

According to the Law on Health Protection of the Republic of Belarus, state policy on health protection is based on the following principles:

* free and accessible medical care;

* health protection directed towards disease prevention; priori­ty for medical care to mothers and children;

* responsibility for citizens' health rests with state bodies as well as employers.

The Parliament formulates health protection policy, determi­nes strategies for health protection, approves national medical programs, monitors observance of health protection laws and approves the state budget for health protection of the popula­tion.

The President and the Cabinet of Ministers planand approveprograms for health protection and medical science develop­ment, including programs for eliminating the negative consequ­ences of the Chernobyl nuclear plant catastrophe, pharmaceuti­cal education and scientists training; develop national plans;

plan and approve medicine and medical equipment production programs; provide sanitary protection for the territory, sanita­ry and epidemiological protection for the population, and protection from radiation.

The Ministry of Health of the Republic of Belarus directly governs the work in this sector. It manages the professional activities of all the bodies, organizations, institutions and enterprises of health protection, irrespective of their ownership or of the ministry they belong to, and also the activities of private medical and pharmacy workers; organizes and controls professional training of medical and pharmaceutical workers and coordinates research in the field of health protection; and approves sanitary hygienic and sanitary epidemiological norms and standards and sets rules for their enforcement.

Local bodies are responsible for the health of citizens living on their territory. They provide financing for the health protec­tion agencies they control; carry out sanitary hygienic and sanitary epidemiological actions, undertake measures for pro­tecting against radiation in production activities in state bodi­es, enterprises, institutions, organizations and public unions; are responsible for the development and material and technical efficiency of the health protection institutions under their authority; approve of and finance regional medical programs; and license certain kinds of medical and pharmaceutical activi­ties.

Financing of health services

Financing for state health protection services is based on per capita expenditures for health protection. The part of the expen­ses to be spent annually for this purpose is set by the Law On the State Budget of the Republic of Belarus, but should not be less than 10 % of the national income.

Over the last 5 years, financing of health care has accounted for between 4.8 % and 5.3 % of national income, due to the decline in national income as a result of the worsening economic situation in the country. These funds cover no more than 50 % of demand.

Sources of financial contributions to health protection include:

*state budget funds; non-budgetary funds of local Soviets of Deputies; donations from enterprises, institutions, organiza­tions, public unions and individuals; donations from foreign citizens and persons without citizenship; compensation from legal suits won by health protection bodies brought against enterprises, institutions and organizations to reimburse costs of restoring health following accidents and violations of technical procedures which caused loss of health in citizens; and payment for medical services not financed by state health protection programs or medical insurance funds.

Institutions of health protection can also be financedbyorganizations that deal in medical insurance.

In 1994, 11.6 % of total budgetary expenditures were allocated to health care (7.5% in 1990 and 11.3% in 1993). Of that sum, 14 % was allocated for buying medicine and dressings, 14 % for purchasing equipment, 24 % for salaries of institutio­nal workers, 6 % for meals in medical institutions and5 % forconstruction and repair of buildings.

This amount is not enough however. Reduced availabilityofmaterial resources and maintenanceof equipment,as well aslack of modern diagnostic and treatment equipment can be observed in health care institutions. Availability of medicine is an acute problem for the Republic. There is some local producti­on of pharmaceuticals, but the reagents must be imported and paid for with scarce foreign currency supplies. There is no local production of vaccines, which again must be purchased with scarce hard currency. Serious consideration is being giventodeveloping a pharmaceutical industry within Belarus, and a sta­te program for developing this industry, by the year 2000, is being worked out. With the development of a market economy, private medicine is beginning to develop.

The package of services offered is growing,including those of non-traditional medicine, but private medicine is still not widely practised.

Access to services

Health care in the Republic of Belarus is characterized by a high availability of medical personnel and hospital beds. In January 1995, there were 44,600 doctors (43.3 per 10,000 of the population) and 117,600 professional medical workers such as nurses and technologists/technicians (114.2 per 10,000 of the population). General practitioners account for 26 % of the total medical personnel, paediatricians for 11%, surgeons for 12%, dentists for 8 % and obstetrician/gynaecologists for 5 %. There are 128,500 hospital beds (125.4 per 10,000 of the population).

A well-developed network of treatment and preventive care institutions provides medical assistance (871 hospitals, inclu­ding 428 in rural areas, and 1579 out-patient and polyclinic institutions, including 789 in rural areas). There are 204 ambu­lance stations. In rural areas, 2960 doctor's assistants and midwifery centres offer assistance to the population living in a 7 to 8 km radius. Doctors of out-patient and district hospitals offer assistance within 10 to 12 km.

At the same time, the system lacks horizontal integration which leads to a fragmentation of individuals' health problems among several specialists.

For example, during the courseof having a baby, a woman will see one specialist (obstetrician/gynaecologist) during and after pregnancy (or several if she has health problems) and will be attended by different specialist (s) at the time of delivery.

There is also a strong emphasis on curative and institution-based care, with little attention to Primary Health Care. Some 80 % of sick children begin and end their treatment in polyclinics.

Access to highly-qualified and specialized medical assistance for the population in rural areas was reduced in 1993-94, due to a considerable reduction in public transportation necessitated by the economic situation.

The state health care system includes health care institutions under the jurisdiction of the Ministry of Health (92 % of doctors work in these) as well as health care services belonging to the Ministries of Defence and Internal Affairs and to the Belarusian Railways.

2. What changes would you like to introduce in the National Health Care Services in Belarus? Discuss it with your partners.