Health Minister Vojsilav Šimun said that his primary goal is the depoliticization of the health system and that directors will not be chosen based on party affiliation. In an interview with "Vijesta", he said that the health system lacks doctors, that the infrastructure is very poor and that there are no treatment protocols, which are the main challenges that he will work on during his mandate. He also claims that they recognized that the patient's path through the health system is often complicated and burdened with unnecessary administration.
Šimun also said that they are currently checking the work of the managers of health institutions and that, where they identify problems such as employee dissatisfaction or poor quality of service, they will take measures and even replace the directors.
How do you assess the state of the health system, two months after assuming the position of Minister of Health? What are the key problems and challenges that need to be worked on in the coming period?
The key challenges facing the healthcare system can be divided into several categories. First of all, we are talking about the personnel deficit, considering that the health system of Montenegro lacks a certain number of doctors. We are currently working on the Plan for the development of personnel in the field of healthcare for a period of 10 years, with which we will map the system and precisely determine how many doctors are missing and what is the profile of the doctors. Also, this document will cover other medical as well as non-medical workers. Furthermore, the health system faces a very poor infrastructure. We all know that for decades no investment was made in infrastructure and the construction of new facilities, so we can state that most of our health institutions are dilapidated and that serious reconstruction and investment in that field is needed. Also, we have a big problem with the lack of equipment, and that in certain institutions of essential equipment. Equipment must be continuously invested in, given that technology advances rapidly and requires the healthcare system to keep up with these trends, in order to create the conditions to provide our patients with the highest quality healthcare. Also, as a very significant challenge, I would highlight the lack of a treatment protocol. We know that protocols are the foundation of any quality healthcare system, and that they simultaneously protect patients and doctors, but also enable monitoring and evaluation, and ultimately a high-level quality control system. Along with the development of protocols, I would single out the poor level of digitization as a major drawback of our healthcare system, which leads to a lack of data and the impossibility of monitoring quality indicators. We are actively working in this field, because the digitized system provides many benefits, such as the high-quality connection of all levels of health care, the creation of a good database so that they can create a better health policy, then the integration of the private and public system, then facilities for health workers when providing health care, such as and many other indirect benefits. Also, we have actively started work on the reform of the system of procurement, distribution and monitoring of drug consumption, with a key focus on ensuring the availability and continuous supply of drugs.
How do patients manage in such a system?
In addition to these challenges, we recognized that the patient's journey through the healthcare system is often complicated and burdened with unnecessary administration. Therefore, we will work on simplifying the scheduling system in order to make appointments for individual examinations more accessible. Our goal is to relieve both doctors and patients of unnecessary administrative procedures. By relieving and improving primary health care, we will make it available to patients, thereby achieving universal health care and enabling 70-80 percent of health services to be provided at the primary level. These steps will be crucial in ensuring that our healthcare system becomes more efficient, accessible and patient-oriented.
All these are just some of the problems we face every day and which we strive to eliminate in the coming period. Certain normative changes are underway, which will create the conditions for a significant improvement of the healthcare system.
How do you evaluate the work of the management of health institutions? Are there certain management changes now? Whose work would you praise, and whose work do you receive the most comments from employees in the health care system?
When it comes to the work of the management of health institutions, my approach is objective and based on facts. Currently, we conduct thorough checks to evaluate the efficiency, professionalism and ethics of the work of managers in all healthcare institutions.
My main goal is to ensure that every healthcare facility provides the highest standard of service to patients and that the working environment is satisfactory for all employees. Based on this evaluation, wherever we find a high level of professionalism, efficiency and employee satisfaction, and where patients are satisfied with the services, the management will be praised and supported in further work. On the other hand, where we identify problems, whether it is employee dissatisfaction or poor quality of service provided to patients, we will not hesitate to take appropriate action, including the removal of managers if this proves necessary.
Are management positions at the primary, secondary and tertiary levels of health care divided according to coalition agreements? As a minister, will you finally start depoliticizing the health system and give up the practice of your predecessors, who elected directors primarily on the basis of the party key?
As Minister of Health, my primary goal is to depoliticize the health system. I firmly stand behind the principle that the appointment of managers in health institutions will not be based on party affiliation, but on expertise, professional integrity and leadership ability. I expect concrete results from the director that will contribute to the improvement of working conditions in the institutions and, most importantly, to raising the satisfaction of our patients. We will strive to preserve and increase the reputation of health care institutions by choosing quality management staff and ensure the trust of citizens as users of their services. Through this approach, we guarantee that decisions will be made in the best interest of public health, not political interests.
How do you evaluate the move of the predecessor to rename the general hospitals in Berane and Kotor into clinical-hospital centers by decision of the Government, despite warnings that they do not meet the requirements of tertiary health institutions. Do you think this decision was legal and will you reconsider it?
We certainly reviewed the legal basis for the reorganization of general hospitals and the change of status to clinical-hospital centers. Pursuant to the current Law on Health Care, the aforementioned general hospitals meet the requirements to be clinical-hospital centers. However, the fact is that at the first moment it is not at a satisfactory level and certainly the focus in the future period will be on strengthening these institutions, so that they can provide high-quality services of the tertiary level of health care for citizens from the north and south of the country. The ultimate goal is to relieve the Clinical Center of Montenegro, which provides about 1.500.000 services annually, which, you will agree, is a huge pressure on a health institution. Also, we strive to make health care more accessible to our patients from more distant parts of the country. The focus will be on surgical and internal branches, and above all cardiology and oncology, given that the greatest pressure is in that field. Many years of investment and efforts are ahead of us, in order to create renowned institutions of the tertiary level in the foreseeable future.
In the Healthcare Development Strategy for the period until 2027, the outflow of professional staff is recognized as one of the key threats. What will you do to prevent further departure of experienced staff and replace the loss in the public health system?
As I have already said, the preparation of the Personnel Plan in the field of healthcare for the next 10 years is underway. The aforementioned document will analyze personnel potentials in detail. Along with the mentioned activity, we have already started a series of activities that will greatly contribute to creating better conditions for working in the public sector and certainly motivate doctors to stay. The goal is to relieve doctors of excessive pressure, so that they have enough time to devote themselves to each patient in a quality manner. Also, it is necessary to continuously invest in infrastructure and equipment, in order to keep up with world standards and conditions in which healthcare workers should work. I think those are the main complaints at this point.
We will also involve healthcare workers much more in the decision-making process, in this sense we have organized initial meetings with representatives of professional bodies as well as trade unions, and this should lead to greater commitment and job satisfaction (because decisions will be made respecting the opinions of those who are in the process of work and know the issue best).
The protector of human rights and freedoms warned in the previous period, when deciding on patients' complaints, that in addition to endangering the lives of patients, the state could be held accountable before the European Court of Human Rights in Strasbourg because the Ministry of Health does not take sufficient measures to enable them as soon as possible organ transplantation. When will the transplant program be moved from a standstill and what are your next steps in that area? How do you view the fact that not a single organ transplant has been performed in the largest health institution for years, and who is responsible for that?
The Ministry of Health has launched an initiative to establish a system for issuing donor cards in health centers, which are provided with special printers for printing donor cards as well as a sufficient number of donor cards, all with the aim of implementing the umbrella law in this area - the Law on the Removal and Transplantation of Human Organs for the Purpose treatment.
Raising citizens' awareness of the importance of organ donation is essential for the development of a cadaveric organ transplantation program. In communication with the media, health workers, educational institutions and all other important social factors, the Ministry will organize a good campaign to raise awareness among citizens about the importance of organ donation, for which the budget of the Ministry of Health for 2024 provides the necessary financial resources.
I would like to use this opportunity to invite all interested citizens who want to receive their donor card, they can do so by contacting their chosen doctor at the health center according to their place of residence to obtain a donor card and give consent for organ donation.
In the earlier period, cooperation existed in the way that doctors from the Republic of Croatia performed transplant operations in KCCG. After the expiration of the agreement that KCCG had with KBC Rebro, the Ministry of Health initiated the continuation of cooperation several times, both directly and through diplomatic means, but the answer from the other side is still missing. So that the transplant program would not suffer, this was overcome by referring patients for related liver and kidney transplants to treatment outside of Montenegro. On the topic of starting the transplant program, we had a meeting with representatives of the Ministry of Finance and the KCCG, where, after reaching an agreement in the Government, we made a decision to send a team of doctors to the University Clinic in Munich for training in the field of kidney transplantation, for which appropriate funds were provided, and in the spring In 2024, he expects the start of training and then the formation of a domestic team for these medical procedures. Also, during the signing of the cooperation agreement with the APHP clinic from Paris, there was talk of expert assistance in this area, so we will try to use this possibility.
How does the Ministry plan to combat extremely low immunization coverage?
The Ministry of Health, together with the Institute for Public Health and all institutions responsible for the implementation of the Immunization Program, continuously undertakes a series of activities to ensure that vaccines are available and accessible to those for whom they are intended in all parts of Montenegro.
In order to face the challenges of low immunization coverage, especially with certain vaccines, an Action Plan was created and a Commission was formed to improve routine immunization coverage.
Also, the Commission for amending the regulations in the field of mandatory immunizations was formed, which should prepare adequate proposals to improve coverage of immunization by changing certain regulations.
Following the proposals of the Expert Advisory Body for Immunization of the Ministry of Health, as well as the Institute of Public Health, we will strive to improve the Immunization Program by introducing new vaccines, as well as expanding the availability of certain vaccines for several age groups that are already in the Program (pneumococcus will be newly introduced, and HPV is being expanded and we will also recommend it to boys).
Strengthening the health system in terms of more effective referrals for immunization and better accessibility, improvement of cooperation with the NGO sector, international organizations and changes in regulations in this area will be the focus of our activities.
We will expand the range of cancer screening
How will you fight against the epidemic of chronic non-communicable diseases, which are the cause of over 90 percent of all deaths in Montenegro?
At the Ministry of Health, we are very aware of the challenge posed by the growing burden of chronic non-communicable diseases such as hypertension and cardiovascular diseases, which are among the leading causes of mortality in our population. In response to these challenges, the Ministry of Health has prioritized improving the control of hypertension and other major risk factors for cardiovascular disease.
In cooperation with the World Health Organization (WHO), we have already started concrete steps in this fight. A group of WHO experts visited Montenegro at the beginning of December and held a series of meetings with representatives of the Ministry of Health and health institutions at all levels. Based on these conversations and detailed analysis, we are preparing a situational analysis that will be the basis for defining and implementing concrete activities such as strengthening the knowledge and competence of medical workers, setting a set of indicators, introducing an alarm system that will warn the medical worker about a patient with risk factors, etc. . The goal of these activities is better control of risk factors, primarily hypertension, which will lead to a reduction in the incidence and mortality from cardiovascular diseases among the citizens of Montenegro.
Also, through its actions, the Ministry of Health will emphasize the importance of preventive measures, education about healthy lifestyle habits and regular medical examinations as key factors in the fight against chronic non-communicable diseases. These measures include the promotion of a healthy diet, physical activity, reduction of tobacco and alcohol use, as well as regular health monitoring, especially in high-risk individuals. Three screening programs are also implemented: breast, colon and cervical cancer screening, with a tendency to expand the range of screening programs.
All these activities represent an integral part of our strategy for improving the health of the citizens of Montenegro and reducing the burden that chronic non-communicable diseases represent for the health system.
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