Incongruent to the needs staffing with various specialists

Drugs – forcing patients absorb expenses for drugs

It is worth noting that the increase in financing over the period from 2002-2003 did not yield the desired result, except for the annual increase of 5-7% in the number of patients treated in hospitals. Despite repeated increases in wages of medical staff (by 20% in 2004 alone), the official average salary in the sector is half of the national average.
There is still a problem related to the fact that the obligations assumed by the state to ensure guaranteed benefits package to the population are inadequately funded. Paid health care services take the place of free medical care. Due to the lack of clear distinction between the guaranteed benefits package and health care services provided for a fee, the level of informal payments remains high to the advantage of health workers. The recording of health services provided within the guaranteed benefits program is not properly established, thus promoting the growth of shadow economy.
There is no comprehensive sector policy of resource saving. The distinction between purchasers and providers of health services exists only as a formality, as almost all providers are state institutions, administratively and economically reporting to government health authorities. Health care development is not a priority of regional social and economic policy. Therefore a number of general negative trends could be identified requiring corresponding management decisions.
First, the most important principle of organization of the health care system – continuity of health care provision throughout the system— does not exist as it should.
Second, inequity is observed in quantity and quality of services provided as well as in basic indicators of health care development across different areas within the same province.
Third, the mandatory components of the HCS management system, including monitoring and evaluation of performance of health facilities and the health system as a whole are not well developed. Lack of coordinated policy in information support of the health system results in reduction of accuracy of information collected in the sector, late submission of information from sites to province and central level, impossibility of comparing the data collected by different sub-systems. This eventually results in reduction of efficiency of decisions taken on this basis and irrational use of resources allocated for health system.
Fourth, lack of uniform approaches and standards in medical equipment and medicines procurement results in more expensive equipment and medical goods procured as well as problems with the quality of procured goods.
Fifth, lack of coordination of operations of health management bodies with other public authorities directly or indirectly influencing the level of public health (labor and social protection bodies, culture bodies etc.) is observed. This coordination is an important instrument for formulation of a healthy lifestyle and, eventually, it reduces the need in health care.
Sixth, PHC being the central part of the health system should carry out the main function of qualitative improvement of the population health indicators. The efficiency and quality of performance of the entire health system, retention of national labour force capacity and solution of most medical and social problems arising at the level of the family and socially unprotected population groups: children, invalids and aged people depends on its condition. PHC doctor now carries out the dispatcher functions: the frequency of referring out-patients to specialized doctors is extremely high.
Seventh, a major misbalance is observed in the volume of funding of out-patient and polyclinics and in-patient care in favor of the latter. This hampers implementation of modern resource saving methods in provision of health care at pre- and post-hospital stages. This results in wider indications for referral for in-patient treatment, annual growth in numbers of hospital beds and, consequently, in more expensive health care.
Eighth, the state health system is not physically separated from the private one: some state-run health organizations occupy the same buildings as private ones, providing chargeable health care services.
Ninth, lack of properly trained qualified managers in the sector has resulted insufficient management and inefficient use of resources. The manager of a medical facility acts as a manager, administrator, chief doctor, assistant manager, clinician and so on.
Tenth, the health care system activities in current conditions cannot be limited to addressing purely sectoral problems. The comprehensive character of health of the population requires strengthening intersectoral coordination efforts, particularly in the area of health promotion and improvement of social, psychological and ecological environment. In addition, the population is not well- informed and doesn’t take an active part in the health care system. In this respect, it is necessary to choose a clear, publicly understandable, manageable and efficient model for the health delivery system.