STRENGTHENING CENTER FOR PREVENTION IN PRIMARY HEALTH CARE CENTER “ZEMUN”

1. STRENGTHENING CENTER FOR PREVENTION IN PRIMARY HEALTH CARE CENTER “ZEMUN” Dr Olivera M. ĆIRKOVIĆ Prof. dr Milica Prostran Dr Mladen Jecmenica Dr Gordana Markovic

2. Area: 88,361 km2 Population: 7,498,001 (Census 2002) Administrative structure: 24 districts 160 municipalities Aging: 17.2% are older than 65 years (2005) Life expectancy at birth: 70 m, 75.4 f (2005) Literacy Rate: 96.6% Unemployment: 31.79 % (2004) GDP: US$ 2,300 per capita (2005) Health Expenditure: US$ 260 (2005), 7.6% GDP Below poverty line: 10.6% (2003) – US$ 2.4 per day Crude death rate : 14.3 (2005) Republic of Serbia – Demographic profile

3. Background information • Leading causes of death in Serbia are practically identical to leading causes of death in developed (industrial) countries[1] • The highest burden of diseases in our country is attributed to non-communicable diseases (NCDs). • Until now, health service in Serbia was not effective in addressing the problem [1]Atanaskovic-Markovic Z, Bjegovic V, Jankovic S, Kocev N, Laaser U, Marinkovic J, Markovic-Denic Lj, Pejin-Stokic Lj, Penev G, Stanisavljevic D, Šantric-Milicevic M, Šaulic A, Šipetic-Grujicic S, Terzic-Supic Z, Vlajinac H. The Burden of Disease and Injury in Serbia. Belgrade: Ministry of Health of the Republic of Serbia, Belgrade; 2003.

4. Background information • Cardio-vascular diseases and malignant tumours contribute to more than three quarters of all causes of death in 2005 • More than half of deaths in Serbia (56.8%) were deaths due to cardio-vascular diseases • Almost every 5th death (18.5%) was a malignant tumour victim • Injuries and intoxications were responsible for additional 3.6% of deaths in Serbia • 2.7% were due to COPD (chronic obstructive pulmonary diseases), and complications of diabetes account for 2.4% of deaths

5. All causes NCD Cancer Symptoms and nondefined causes Injuries Communicable diseases

6. Priorities for the next Bi-Annual period have covered: • prevention of mass chronic non-communicable diseases and risk factors for their appearance • development and planning of human resources for health, • health system development directed towards inequalities in health • constant improvement of the health protection quality • development of health information systems and introduction of new models of financing • as well as strengthening country capacities for timely response to different dangers for public health

7. Epidemiological study showed that the CRC incidence in Serbia is around 45/100,000 inhabitants, thus the incidence in Serbia is very close to the one existing in the developed European countries [Krivokapic Z. Consensus conference, diagnostics and treatment of colorectal cancer. Belgrade 2002: 44-54)

8. Breast cancer is the most frequent malignant tumor among women • There are 4000 newly registered cases a year, which represents more than a quarter of all malignant illnesses among women • 1600 women die of breast cancer annually, which makes up for around 18% of the mortality rate caused by cancer(Source-Project proposal “Preparation of the programme and implementation of prevention, early detection and treatment of malignant breast cancer,” Project of the Institute for Oncology and Radiology of Serbia)

9. According to the WHO data, our country has the highest incidence of cervical cancer in Europe. According to the 2002 data the standardized cervical cancer rate in Central Serbia was 27.2 per 100,000 women. (Source – Cancer Register of the Republic of Serbia, without the data for AP Kosovo and Metohija)

10. Objectives: • Center for Prevention as a new department within primary health care centers has a role to coordinate and conduct preventive activities on local level as well as to develope cooperation with partners in a community

11. Establishment of a modern public health services, based on the rule of equity • Rehabilitation and modernization of the existing health services in PHCC • Fighting poverty and improving health and social conditions for the most vulnerable groups

12. Center for prevention in Zemun was establish in 2006, but just since end of 2007 started with everyday work in deffferent fields

13. Results: • 4 subunits fuly developed

14. Results: • More then 3000 visits • School „Quit smoking“ (27 patients) • Screening carcinoma mammae passed 440 patients • 12 workshop themes chosen by patients • 3 carcinoma screening programs • 12 „Health Market“ events

15. Tasks for the future • To create long term, strong partnerships between local governments, governmental institutions and non-governmental organisations • Finding new ways to reach our vulnerable citizens in the community with essential services provided through Centers for prevention • Introducing the concept of community based Centers for prevention that serve population with limited access to health care to other municipalities or region where those three sectors involvement is not normally considered

16. Conclusion • This unit has shown as extremely important way to reach vulnerable citizens and should be develop as high priority

17. chirkovich_olja@yahoo.com Thank you