Kosovo Human Development Report 2010 - UNDP Kosovo - United ...

ported deaths. However, Kosovo faces
a number of risks including a growing
rate of intravenous drug use, sex work
related to crime, low knowledge and
awareness about HIV and prevention
methods, a stigmatized and discriminated
MSM 127 community, a rapidly
changing context of social norms, the
presence of a large mobile community
and a health sector that is struggling
to respond. 128 These factors warrant effective
multi-sectoral preventive interventions
in the long run. 129
4.2
Mechanisms and
drivers of exclusion
from the health care
system
As numerous examples from Central
and Eastern Europe demonstrate, a
strong legal framework is not sufficient
to ensure access to health care and
sustain improvements in health outcomes
for socially excluded groups. In
Kosovo, the drivers of health care exclusion
are institutional, socio-cultural
and environmental. They can be defined
as:
(i) A health care policy and financing
gap: unlike other sectors, where contemporary
legislation has upgraded the
inclusiveness of policy frameworks,
the MOH and other health authorities
have not accounted for the needs
of particularly vulnerable groups during
policy formulation. For instance,
mobile groups, including Kosovo-RAE
communities as well as Internally Displaced
Persons (IDPs), are not allocated
any special types of outreach services
under the law. As a result, these groups
struggle to access such basics as quality
antenatal care and family planning
services – leading to unplanned pregnancies
and poorly-cared for babies. 130
In addition, Kosovo’s health care sys-
tem is poorly financed and its limited
resources are not efficiently managed.
Poor health financing is identified as
one of the main factors contributing
to poor health outcomes and inequalities
in health care. The cost of health
care in Kosovo is largely passed onto
the patient. 131
Table
4.3
Kosovo expenditures on
health (million EUR)
Kosovo expenditures on
health (percentage of
GDP)
Kosovo expenditures on
health (percentage of
overall expenditures)
Primary health care
grant (percentage overall
expenditures on health)
Expenditures on health 2004-2009
Source: MEF; MLGA, SOK Kosovo Government Accounts 2004 – 2008; *MEF 2009.
In absolute terms, Kosovo’s allocation
for health care remains relatively
low, at 35 to 45 EUR (i.e., 50 – 75
USD) per capita, which is three to five
times lower than that in neighboring
countries. Based on the WHO Statistical
Information System data for 2006,
Albania allocates 174 USD, Macedonia
245 USD, Serbia 247 USD, BIH 258 USD,
Montenegro 306 USD and Slovenia
1,599 USD per capita to health care. 132
(ii) Poverty and lack of social cohesion:
poverty, social exclusion and
health are strongly interrelated. Poor
health can lead to social exclusion and
poverty, while there are many ways in
which living in a state of poverty and
social exclusion can influence health
outcomes. The World Bank estimates
that 45 percent of Kosovans live in poverty
and 18 percent in extreme poverty.
In general, people with lower levels of
education, occupation and/or income
2004 2005 2006 2007 2008 2009
64.6 71.4 68.3 70.1 62.6 74.5*
2.8 3.2 3.0 3.1 3.0 2.8
10.4 9.6 9.8 9.8 9.7 9.2
28 25 26 27 26 26
HEALTH CARE SERVICES AND EXCLUSION
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