District-level activities for improving quality health services - Croatia
In accordance with the 'WHO Quality Health Services: a planning guide' [ https://www.who.int/publications/i/item/9789240011632 ], one of the key functions for leadership at the district level is the support to health facilities in achieving stated aims. Furthermore, the guide states how district-level leadership should ensure that the foundational requirements to support quality health services are functional, and at the same time maintain engagement with national level. These are some ideas that were actually considered when Croatia aimed to implement the decentralisation reform during the last couple of decades, which is actually something that all transition countries go through - with an end-goal to suit district-level needs and ensure a health care system that is better, more fair and more efficient.
Accordingly, one of the strives was the change in the ownership of hospitals and primary health care centres, which was transferred to local authorities in order to plan and manage health care on a district level. However, the problem was that the reforms were not based on the problem analyses and resource assessment, but rather on maintaining the framework within which they were implemented. The WHO planning guide highlights adequate resource management as one of the key district-level considerations. Also, there is a need to pose the following question (also formulated in the planning guide): What is required to support management for quality health services?
Consequently, this was partly a haphazard approach that has resulted in a complete change of the essence of the district health system, whereas the given framework imposed limitations on the development and changes instead of fostering them. The situation in Croatia confirmed a huge shortage of relevant policy research and analyses in health care. Such a situation was mostly caused by lack of systematic education about methodology and possible tools for health planning and quality management, which means quality of care goals were still not reached completely. In addition, Croatia is a country with extreme differences between its regions and districts, which also has to be taken into account when the aim is to develop and sustain foundational requirements for quality of care.
HIFA profile: Tomislav Mestrovic is a medical doctor and a clinical microbiologist with a PhD in biomedical sciences, and an Assistant Professor at Croatia's youngest public university, University North. He is also passionately invested in global health communication, health literacy, science journalism and science diplomacy. Tomislav was appointed by the Ministry of Science and Education of the Republic of Croatia as a Managing Committee Member to COST Action on evidence-based medicine run by the European Union. He holds several positions in international societies that resulted in many volunteering initiatives. Tomislav is the current holder of the HIFA Country Representative of the Year award (2020) and is also the European coordinator for HIFA Country Representatives. He is also a member of the HIFA-WHO working group on Learning for quality health services.
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