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Evaluation of the organization and provision of primary care services in Belarus: application of the WHO Primary Care Evaluation Tool (PCET).

Boerma, W.G.W., Wiegers, T.A., Kringos, D.S., Pellny, M. Evaluation of the organization and provision of primary care services in Belarus: application of the WHO Primary Care Evaluation Tool (PCET). European Journal of Public Health: 2009, 19(suppl. 1), p. 75. Abstract. 17th European Public Health Conference 'Human Ecology and Public Health', 25–28 November 2009, Lodz (Polen).
Background: The study aimed to assess primary care (PC) policy and service provision in Belarus at the national level and from a perspective of physicians and patients. Methods: The PCET is an instrument that has been developed and tested for WHO Europe in 2007–08, specifically for application in health care systems in transition. The tool consists of a checklist to gather information at the national level; a questionnaire for PC providers; and a questionnaire for patients. The application of the (translated) tool was carried out in Belarus between October 2008 and February 2009. Fieldworkers supported surveys were held among random samples of physicians and patients in two regions of the country: Vitebsk and Minsk. A draft report has been discussed in Minsk in March 2009. The final report is expected in June 2009. Results: Results among 235 physicians and 1755 patients showed that the centralized hierarchical health care system left very little space for regional health policy development. Health system reform proceeded by incremental change and PC reform started relatively late. A PC model based on general practitioners (GPs) was adopted for rural areas only. Recruitment and retention of GPs was difficult. NGOs and patients organization were not involved in health policy development. PC practices were psychically well accessible during opening hours, but not by telephone. The accessibility during out-of-hours could be improved. Patients were satisfied with the way they were treated, but less so with waiting times. Even though physicians formally had no gate-keeping role, to some extent they acted as such. However, their coordinating role for the care process of the patient could be improved. Retrained GPs provided more comprehensive services compared with PC physicians in the traditional settings. Conclusions: The results of the application of the PCET in Belarus have shown that GPs make a difference in Belarus PC. However, at present only 10% of physicians in PC are GPs. It is now time to continue and speed up the realization of old policy intentions.