Commentary of the development of Palliative Care in Serbia

Categories: Policy.

The article also reported that “at this moment four centres for palliative care are fully operational, while by the end of the year there should be 20 of them”.

Palliative care is currently being integrated into the health system in Serbia, with an emphasis on the delivery of palliative care in the home through the local Dom zdravlja and the development of palliative care units.  Transport to visit individuals at home has been a challenge and it is anticipated that these vehicles, provided by the European Union, will be used by the home care teams to increase accessibility of palliative care within the home.

At present, Serbia is on the verge of major developments in the field of palliative care. Several strategic moves were made in recent years to lay the groundwork for specific developments, including the adoption of a National Strategy for Palliative Care in February 2009, setting out a policy framework for the improvement of provision of palliative care at all levels of the health care system, including home care teams, primary health care, general hospitals, and tertiary care institutions.  One of the over-arching principles guiding the development of services is that access to palliative care, and relief from illness-related pain and suffering, is a basic human right. Therefore it is important that care is made available through integration into the existing government health system in Serbia.

The National Strategy also includes an ambitious action plan which identifies up to 28 sites where PCU’s will be developed. Several of these have recently become functional for example Zrenjanin and Sombor, and others are due to open imminently e.g. Leskovac and Nis.

Since 2011, the EU-funded project, “Developing Palliative Care services in Serbia” has been providing technical assistance to the Ministry of Health and other key stakeholders to implement the Strategy and Action Plan. The project is implemented by Oxford Policy Management in consortium with hospices from Serbia, Romania and the UK. Work has focused on training health and social care professionals working in the sites, and in providing support to the Ministry of Health to develop the units. The Ministry of Health is supporting hospitals to develop the PCU’s through providing some additional funding for refurbishment and the project has reviewed potential sites and recommended which are most suitable. Work is currently underway in a further 14-16 sites with the hope that they will be able to open PCUs within the next year.

However, having the physical environment is not enough for the development of a PCU, health professionals need to have the right attitude and embrace the philosophy of palliative care to ensure that the care being provided in these units is truly holistic, focusing on quality of life and addressing physical, psychological, social and spiritual issues. A comprehensive training programme has been designed and is currently being delivered both on an academic level, for undergraduate nurses, doctors and social workers, and as continuing professional training for all health care disciplines. Policies and procedures also need to be developed and implemented so that there is a seamless continuum of care between palliative care provided in the homes and that in the PCU’s. There is therefore on-going work on the model of palliative care provision, including best practice guidelines, standards, quality indicators and policy. Support has also been given to a number of hospital sites across the country to develop palliative care units and clinical supervision and mentorship has commenced in some of the existing PCU’s and their associated Dom zdravlja. 

It is exciting to see the gradual development of palliative care services in Serbia, though daunting as to the support that will be needed if all 20 units are to open in the coming year.