PHC duplication of services
Those who referred to PHC – 20% were redirected to other clinics, 70.6% were referred to hospitals. While PHC by nature should address 90% of admitted cases!!!

PHC – poor organizational identity impeding formulation of concrete package of services, disabling integration and prophylactic measures at municipal level.
Hospitals – duplication of services, inefficient distribution of resources

To date the allocation of resources from local budgets to inpatient care within the guaranteed benefits package has exceeded PHC expenditures by three times, while the health care delivery system remains predominantly inpatient-based.
As a result of excessive hospital admissions, the number of hospital beds along with the average length of hospital stay has been increasing consistently since 2000. The main reason of why people prefer hospital treatment to outpatient care is the lack of drug provision at out-patient level and the insufficient quality of services provided at primary level. Inpatient care has not been standardized so far (with the exception of republican health facilities), with the quality assessment system being inadequate

The current health care quality assurance system faces a number of problems. Administrative measures do not motivate the staff and managers to improve their performance; proposals aimed at addressing problems in provision of health care are seen as recommendations and are not often followed; there is a lack of linkage between internal and external quality assurance. In addition, health facilities related to different agencies, as well as state institutions and health facilities that are not contracted for procurement of health services fall out of the system.