Establishing Decentralized Service Improvement Network (DSIN) for primary health care: the Serbian experience

Abstract

Issue Serbia started the process of decentralization soon after the first phases of reforms were completed, as the integral part of the European integration process. The Law on Health Care has enabled decentralization in the primary health care sector, in order to strength the democratic governance and to improve administrative and service delivery effectiveness. Through the project with the Norwegian Association of Local and Regional Authorities (KS), the Serbian Standing Conference of Towns and Municipalities in cooperation with public health experts, assisted capacity building of local authorities. The aim of establishing Decentralized Service Improvement Networks is to advance the role of local authorities in public health and primary health care institutions, and to foster horizontal coordination between other social policy areas. Description of the problem Local governments were not aware of opportunities they have as founders of primary health care institutions- to monitor the effects of the undertaken measures in the field of financing, preventive actions and public health protection. Results DSIN for primary health care was established for the six chosen municipalities, comprising of at least 3 representatives of each local government. The cycle of 6 meetings started with a managerial meeting (mayor, heads of the services) in order to agree on a coordinated approach in the municipality and pointing out the challenges for such approach, applying SWOT analysis. DSIN have improved access to relevant statistical and administrative data, set the list of indicators to be monitored at the local level, developed and piloted the methodology for periodical survey of users satisfaction with primary health care and actively analysed and shared experiences (local and international). Furthermore, this network sucessfuly cooperated with the relevant institutions from education, social protection, NGOs, and users of services. Based on the review of all collected relevant data, every municipality have chosen to improve one priority public health service. Lesson The practice of DSIN is based on critical analysis of own performance in the context of performance of other similar institutions, on the basis of opinions of clients of the service and with wide utilization of best practices tested already in other local governments. Key messages Professional network at the local level motivates municipal authorities to perform better, to adopt innovative approaches and to learn from other experiences and good practices. The network enables local governments to learn from each other and to discuss and agree how to best use emerging good and European practice to improve the target services in their municipalities.