Occupational Health Kosovo RilindZenelaj&Xhevat Shkodraˡ ’² ˡ Professor at Faculty of Medicine²Manager at Red Cross of Kosovo
Flag of Republic of KosovaThe Republicof Kosovo is located in Balkan Peninsula in south-eastern EuropeThe Republic of Kosovo declared independence on 17 February 2008Surface of Kosovo is 10,908 square kilometers.Population (2011 census) 1,733,872Density 159/Male50.4% 873,598Female 49.6% 860,274Life expectancy female,years 71Life expectancy male,years 67Population below of age 14 years 28%15-64 years 65%>65 years 7%Employment Over 250,000GDP per capita(2010),Euro 2,383
Labor force Employment During the period 1999- onward the Kosovar labor market wentthrough important changes and one of the main factor is the privatization process of the state-owned enterprises. The average number of employed persons in private sector has a tendency toward increasing. In 2010 the level of employment of the central age group(25-54) was 34%. The main branch of economy in 2009 has been tradingwith participation of employment 17.4% followed by education (13.4%),production(9.9%),administration (9.8%) and construction(7.9%). Figure 1.Level of employmentUnemploymentThe male unemployment rate in 2009 was 37.4% of central age group (age 25-54)Female unemployment was 52.0% Analyzing the unemployment by demographic group,there is an increasing trend in the registeredunemployment persons belonging to the age of 15-24
Figure 2.Level of unemploymentOccupational Health and Occupational Health LegislationOccupational Medicine of Kosovo based on its activity is relatively new. This was organized throughOccupational Medicine in local level of Health Houses (now Main Family Medicine Centre) or through servicesand units of occupational medicine at the other forms of institutional health organization in Kosovo.Being faced of occupation circumstances of last decade, this segment of health passed through importantchanges to its dysfunction.An important role had the Unit of Occupational Medicine at the National Institute of Public Health which alsowas stopped of working.Formally had also the Association of physicians of the Occupational Medicine.Before war (1999) Kosovo has had 65 specialist of Occupational Medicine. Nowadays of Occupational MedicineToday’s in Kosovo are 31 active specialists of OM.This generation belongs to the age of 40-68 years, so it is old and not regenerated.Today’s a few of them are working out of their field of specialization as a result of bad organization of OM.Currently, is considered that in Kosovo are employed over 250,000 workers, while quadruple is able andwaiting to work. So the ratio of employees with a doctor is 1:8000, far away fromEuropean norms.
Regional specialists of OM in Kosovo 0% 3% 7% Prishtina (17) 16% Mitrivica (6) Prizren (5) Peja (2) 55% Gjilan (1) 19% GjakoveFigure 3. District distributed specialistsResponsible body on OH1. The Ministry of Health2. The Ministry of Labor and Social welfareMain laws in force for OHThe OH is part of public-public health system. The administrator of Health system is the Ministry of Health.The health system is organized on three levels, primary, secondary and tertiary. The Occupational health is partof tertiary level and is managed by two occupational health institutes, one located in Obiliq (10 km away fromCapital city) and the second one in Gjakova (western part of Kosovo),and 7 local OM services.Presently all health system is ruled based on provisional health law which was adopted by United NationsMission in Kosovo and Provisional Kosovo Self Governmental Institutions (Health law no.2004/4) which isunder revision and very soon there will be a new law foreseen to be adopted by assembly by the end of thisyear. In the other hand there is not special legislation which regulates the aspect of occupational health as aspecific entity.Fortunately, we have a new labor law (labor law No.03/L-212) which was approved in year 2010 and came intoforce in beginning of year 2011. This law talks about the safety in work and the rights of workers. Due to thislaw the employer is obliged to ensure the worker with proper protection in work and provide proper protectivedevices as well as it is obliged to undertake all measures to secure healthy and safe working environment.Novelties in this law are also the extension of sick leaves from 15 calendar days into 30 working days andextension of maternity leave from 3 months into 6 months.As I mentioned our health system is public-public we do not have health insurances fund and the governmentpays all health services. As both occupational institutes are part of health system workers-patients do not pay forservices that they receive but due to lack of fund in some cases some of health services are limited.
The health insurances fund law is under preparation. Major part of it have been concluded but due to financialcost it has been postponed for approval in next year based on advises of World Bank and InternationalMonetary Fund.The rights and obligations concerning labor relations are regulated in order of priority by the following sources:a) The constitution of Republic of Kosovob) The collective contract of employment?c) The individual contract of employmentd) Code of laborOccupational accidents and occupational diseaseThe deficiencies on the accurate evaluation of the occupational accidents are conditioned by the followingfactors: 1. Lack of accident declaration 2. Lack of mild injuries 3. Lack of registration of the self employed persons or part time employers 4. The information about injured persons is deficient etcReporting occupational diseases It is very difficult to report Occupational disease because of: 1. The partial coverage with health service of the enterprises 2. Deficient specialization of doctors engaged full time on health service in enterprises 3. The deficient of cabinets for Occupational disease For this reasons the numbers of Occupational injuries is far away from what is present in the field The most occupational diseases in Kosovo are Pneumoconiosis leads by Anthracosis. Occupational health education Faculty of Medicine There is a subject of Occupational Medicine at least 45 hours for Medical students,and specialization on Occupational Medicine that last 3.5 years. Moreover, there is no training for occupational health nurses.Occupational Health services
Both institutes provide professional services through diagnostic testing of patients. The services are/divided into following departments:• Otorhinolaryngology• Gynecology• Medical laboratory• Ophthalmology• Internal Medicine• Cardiology• Neurology• Psychiatry• Dermatology• Pulmology• X-Ray Department• Occupational MedicineDiscussion1. Low number of OM specialists2. Urgent needs to increase the scientific and professional staff as: sanitary inspector, hygienists, psychologist etc.3. Half of the municipalities does not have OM staff4. More than half of OM specialists are concentrated in Prishtina The future of Occupational Medicine This should be based on: 1. The maximum utilization of existing human resources 2. Continual increasing of professional staff 3. Development of information system within health information system 4. Orientation from curative form to preventative one 5. The recovery of Association of physicians of the OM 6. Establishment of Central Institute of Occupational Medicine
Operating scheme of Occupational medicine DEPARTMENT OF SCIENTIFIC RESEARCH -scientific projects -scientific meeting -edition of scientific magazine MEDICINE FACULTY INSTITUTE OF OCCUPATIONAL HEALTHDEPARTMENT OF PROFESSIONAL PRISHTINE DEPARTMENT OF TRAINING AND DISEASES EDUCATION OF NEW GENERATION -hospital treatment -permanent education -examination -training -evaluation of working ability -specialization Figure 4. Operating scheme of Occupational medicine, done and presented to Government by Prof.Dr. XhevatShkodra
Main Problems? The main problems are: Health system and health financing. There is inadequate financing of health services and health needs, with other words lack of finances offered by government for health sector and there is not clear policy to develop health sector and produce proper legislation for regulate health financing.References1. Shkodra ,Xhevat Prof.Dr.2002 Resurset e tanishmenjerëzore,aktivitetet e tyrenëkuadërtëMjekësisësëPunësdhenevojatpërtrajnim2. Arënliu-Qosaj, Fatime and Koçinaj-Berisha,Merita 2010. Transition in Health and Health Care in Kosovo3. Kosovo Agency ofStatistics,2009.SocialStatistics.Health Statistics.4. ____.2011.Kosovo Census5. ____.2009.Population Statistics6. ____.2009. Economic Statistics.7. ____.2009.Labour Market Statistics8. UNDP.2012. Kosovo Human Development report 2012-Private sector and employment9. Law No. 2003 / 19 On Occupational Safety, Health Andthe Working Environment10. Law No. 2004/4 Kosovo Health11. Law No.03/L-212 On Labor