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Primary care reform in Central and Eastern Europe: can Belarus be taken as the control group in international comparison?

Boerma, W.G.W., Rousovich, V.S., Schellevis, F.G., Egorov, K. Primary care reform in Central and Eastern Europe: can Belarus be taken as the control group in international comparison? European Journal of Public Health: 2005, 15(suppl. 1) 38. Abstract. 13th Annual EUPHA Meeting "Promoting the public's health: reorienting health policies, linking health promotion and health care", Graz, 10-12 November 2005.
Background: Health care reform proceeds differently in Belarus. The country has not followed trends
visible in most other countries. Financing and provision of health care is still in the hands of the
state. Health insurance funds are unknown, private practices are rare and operating outside the
system, and power of regional health authorities is limited. Besides, for political reasons the
country does not benefit from important international aid programmes. Nevertheless, some change can
be observed, particularly in Belarus primary care. A family doctor system is being implemented in
rural areas, where the situation of health care is poor. Since 1998 two subsequent Dutch-sponsored
bilateral projects have supported this development. This paper provides a state of affair of primary
care policy development in Belarus and presents first results from a national survey among primary
care doctors. Methods: Based on official documents and experiences from the authors, primary care
development in Belarus has been analysed in the light of the role of regional health authorities,
educational institutes, and the recently established association of family doctors. The national
survey among a random sample of primary care doctors (including newly re-trained family doctors) in
three regions of the country has been implemented in Spring 2005. The survey instrument has been
used internationally. Results: The do’s and dont’s of health care policy in Belarus will be
presented.First, results of the national survey among doctors in primary care will be presented, in
particular, on the provision of their clinical tasks and aspects of their workload. Family doctor
will be compared to doctors who have not been re-trained; Belarus will be compared with other
countries. Conclusions: Health care develops very slowly in Belarus, but the country cannot be
considered as the open air museum of the Semasko system. (aut.ref.)