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

construction and neglect and abuse of
natural resources. 138 Kosovo also has
the highest incidence of lead contamination
in the world. Outdated
farming techniques and rapid deforestation
for construction purposes
are causing extensive damage to
arable land and Kosovo’s vulnerable
forest areas. Industrial pollution in
cities is very high: use of lignite coal
ejects 25 tons of ash into the air every
hour – 74 times higher than European
environmental allowances. 139
Waste management programmes
for industrial waste from major facilities
such as the Trepça Complex are
unable to cope with the sheer volume
of contaminants. Information
systems that might alert communities
and mobilize a response are also
largely absent. As a result, Kosovans
are mostly their own worst enemies
on the environmental front – contributing
to widespread waste, littering
the land and causing health damage
to themselves and their families
through heavy smoking. Those most
vulnerable to health consequences
from Kosovo’s environment are the
poor and ill-informed, and women
and children without the influence
and resources to change their environments.
For example, UNICEF estimates
that 60 percent of schools
do not have access to safe drinking
water and rely on water from wells
which is often contaminated - affecting
children’s growth and learning
and contributing to a cycle of exclusion.
140
(vi) Absence of specialist services: for
all but the wealthiest Kosovans, accessing
specialist health represents
an enormous challenge. Kosovo
lacks specialist cardio-surgery, oncology
and some tertiary treatment
and diagnostics services. Most patients
have to travel outside of Kosovo,
mainly to neighboring countries
72 | KOSOVO HUMAN DEVELOPMENT REPORT 2010
such as Macedonia, Serbia, and
even Turkey. Despite the lack of reliable
data in this field, the MOH has
reported spending several million
EUR every year to support treatment
of Kosovans abroad. In 2010
alone, the MOH allocated 2 million
EUR from its budget for this purpose.
141 For the period from January
to June 2010 the MOH received 582
applications for treatment abroad,
out of which 293 were supported
by the MOH and went to treatment,
while others are in the process or on
waiting lists. 142 Funds for treatment
abroad are often exhausted by midyear,
leaving patients unfortunate
enough to fall sick in quarters three
and four without options.
4.3 Who is affected by
healthcare exclusion?
(i) Families unable to afford medical
treatment: a health care seeker in
Kosovo today may be asked to find
funds for copayment, prescriptions
and medical devices, diagnostics
and basic health services. Supplementary
costs include travel to
and from health centres, as well as
private, “under the table” payments
for medical staff to facilitate treatment.
In total, these costs add up
to 6 percent of average household
budgets. 143 Several studies indicate
that out of pocket payments for
healthcare in Kosovo accounts for
40-60 percent of overall health expenditure.
144 Medicines are by far the
greatest health cost-burden on families
– 80 percent of Kosovo’s pharmaceutical
market (40-45 million EUR
each year) is financed through out
of pocket payments. 145 The UNDP
Kosovo Mosaic survey shows that
74.8 percent of Kosovans find the
cost of drugs is the biggest barrier