Belarus moving towards a stronger primary health care

Belarus has a strong centralised health care system, with hardly any space for local developments, as a study by NIVEL, initiated by the World Health Organisation (WHO), has shown. A more primary care-oriented system is in progress. The results have been published in a WHO-report.

In recent years, the health care system in Belarus has been changing little by little. Without involvement of non-governmental organisations, the government is trying to develop health care into a system with strong primary care in which the general practitioner has a pivotal role. Only one out of ten doctors is general practitioner and training and education are insufficient to increase the number rapidly. As an emergency procedure, doctors are obliged to work temporarily as a general practitioner, without having acquired the necessary skills. The researchers advise to develop as soon as possible a large-scale training for doctors to gain skills as a general practitioner.

Young general practitioners
In future general practitioners may function as coordinators and gatekeepers, with the result that access to health care will improve strongly. Patients were, in general, satisfied with the practising general practitioners. They were especially satisfied with the treatment, less so with the waiting times, as the study shows. The newly trained general practitioners in particular make the difference. The service of these younger general practitioners is more extensive and they refer patients less frequently than older and more traditional general practitioners to medical specialists. Additionally, patients thought that the practices were easily accessible during office hours, except for advice by telephone. Accessibility outside office hours could be better and, in particular, more efficient. NIVEL-researcher Wienke Boerma:  “There is no triage or whatsoever on the telephone, resulting in ambulances being sent out in the evening and during the night, as well as in weekends, for every minor complaint.”

Method
The researchers used for their study an evaluation instrument for primary health care developed by NIVEL, the Primary Care Evaluation Tool. The method gives a structural review of the strong points and the weaknesses of the primary health care system in a country, taking into account relevant health care policy as well as the voice of doctors and patients. Policymakers and politicians can use it to set priorities for future policy. For the study in Belarus, the researchers used the instrument in the regions of Minsk and Vitebsk. WHO is using this instrument more and more to evaluate primary health care in different countries. For example, NIVEL is currently using this instrument for the WHO to study primary health care in Kazakhstan, Ukraine and Serbia. In the beginning of 2010 the results of this study will be published. NIVEL has previously undertaken primary care evaluations in Russia, Turkey, Slovenia and Uzbekistan.

NIVEL’s contributions to WHO Europe has also been mentioned in the publication ‘Matching services to New Needs: 10 Years of the Regional Office for Europe of the World Health Organization’ at the occasion of Marc Danzon’s farewell as the Regional Director of WHO Europe.

More information
- WHO funded research