GHF2010 – PS32 – Strengthening Family Medicine Networks in Eastern Europe

Session Outline

Parallel session PS32, Monday, April 19 2010, 16:00-17:30, Room 3
Chair(s): Goran Cerkez, Assistant to Minister in Federal Ministry of Health, Department for International Cooperation and Coordination of Strategy Developments, Bosnia and Herzegovina, Leo Kliphuis, Director, Dutch Association for Organized Primary Care, The Netherlands
Eligibility of the Delphi Consensus Process in Selecting Topics for Continuing Medical Education
Zaim Jatic, Head Doctor, Family Medicine Department, Public Health Centre, Canton Sarajevo, Bosnia and Herzegovina
Changes in Nurses' Family Medicine Related Activities in Bosnia and Herzegovina
Alexandre Bischoff, PhD in Epidemiology, Division of International and Humanitarian Medicine, Geneva University Hospitals, Switzerland
Finding Suitable Approaches to Continuing Medical Education in Family Medicine in Tajikistan
Zulfiya Gulyamova, Clinical Governance Specialist, Sino Project, Tajikistan

Session Documents

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Session Report

Submitted by: Lura Pollozhani (ICVolunteers); Contributors: Stacy Topouzova (ICVolunteers)

Photo by John Brownlee,

The strengthening of family medicine is not an instantaneous process, but rather, one that takes time -- Kaspar Wyss, Co-chair

Mr. Kaspar Wyss opened the session with highlights of the emerging health challenges in Tajikistan and, on a larger scale, in Eastern Europe. The primary objectives of the session were to explore the definition, expansion and continued training of family medicine.

Three main issues would be addressed, namely: How to integrate social services into health care; how to ensure increased funding for family medicine and primary health care; and finally, how to ensure the proper allocation of human resources.

A growing number of doctors prefer to practice in big cities, and patients prefer hospitals to receive medical attention rather than seeking out family physicians. This inevitably results in increased funding for hospitals but diminished funding for primary family medicine. This issue needs to be urgently addressed.

Strengthening family medicine is not an instantaneous process, said Mr. Wyss, but rather, one that takes time. Lobbying and political commitment both play crucial roles. That is why a coherent approach to strengthening family medicine should include many different actors to effectively achieve success.

Mr. Dejan Sredic of the Public Health Centre, Sarajevo, spoke about the Inter-Professional Collaboration in Family Medicine Programmes in Bosnia and Herzegovina (1998 to 2010).

He highlighted the repercussions and aftermath of the regional war. Following the 1995 Dayton Peace Agreement, economic capacity and human resources notably decreased. The major concerns for the governmental health services, besides the lack of doctors, were the inability to provide the patient with one primary health provider, and the lack of an established appointment or registration system for patients.

To address this lack of capacity, the FaMI project was initiated by BiH health authorities in 1998, with the support of the Swiss Government. The project played a crucial role in supporting health sector reforms and improving access to basic health services.

Ms. Emira Dropic, a major player in the FaMI project, elaborated on its composition and orchestration. To date the project has had considerable success. Among its achievements, 861 doctors and nurses have been trained in family medicine. Additionally, four centres for training have been established. Both speakers agreed, however, that inter-professional cooperation demands more than motivation to be implemented.

Mr. Alexandre Bischoff, of the Division of International and Humanitarian Medicine, University Hospitals Geneva, spoke about Changes in Nurses’ Family Medicine Related Activities in Bosnia and Herzegovina. Over the last ten years, the health authorities have prioritized family medicine, and new resources have been allocated to strengthen primary healthcare. Nonetheless, the role of nurses, he said, should not be underestimated, especially in treating epidemic chronic diseases.

A study of the training in Bosnia and Herzegovina revealed that as nurses’ communication activities grew, the time spent with a patient (more than 15 minutes) increased. Further, the number of appointments with doctors and nurses rose considerably. The implementation of family medicine in the region resulted in more and better doctor-nurse collaboration.

In his concluding remarks on subject of chronic disease, Mr. Bischoff emphasized that improved education for nurses was very important because, among other reasons, of their role in managing epidemics.

Ms. Zulfiya Gulyamova, Clinical Governance Specialist, outlined the SINO Project currently underway in Tajikistan. The project was initially aimed at training family doctors over a period of six months. It soon became apparent that more time was needed to re-train these doctors, and the Peer Review Groups (PRG) project was initiated.

The PRG project aims to facilitate dialogue between doctors working in multiple regions of Tajikistan. In the PRG meetings, coordinated and organized by PRG trained facilitators, these doctors share their knowledge and experience. Above all, said Ms. Gulyamova, within these meetings all doctors are equal and learn from each other’s expertise.

The most pervasive issues pertaining to family medicine in Tajikistan include the use of traditional medicinal methods and the fact that some doctors, in order to earn more money, continue to work as specialists rather than as family doctors.

Ultimately, in Tajikistan, peer review groups remain the most effective method of training doctors, initiating dialogue and sharing knowledge relating to family medicine.

These emerging projects have helped improve the practice of family medicine in Eastern Europe and Tajikistan, and they also address many other existing issues in the region. Nevertheless, this session underscored the need for continued development and progress in the region in the field of family medicine.

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