Problem: Ageing population with increasing prevalence of chronic disease and progressive illness; concept of palliative care in Serbia was underdeveloped and end-of-life services had an acute, reactive focus.
Solution highlights: The Ministry of Health established the Palliative Care Task Force and adopted the National Strategy for Palliative Care to guide the development of palliative care across Serbia; partnerships with international organizations, local NGOs and supportive government actors helped secure buy-in at the national level; developing a legislative and political base was essential for creating a foundation on which to build the initiative; securing EU funding provided additional resources to support activities; incorporating a new palliative care philosophy within professional culture required extensive training, communication, advocacy and time; formalizing educational opportunities through university partnerships helped to ensure sustainability.
Description of practice
A growing elderly population in Serbia – with almost a fifth (17%) of the total population over the age of 65 in 2004 – increased chronic care needs and posed new challenges for the health system. A need to increase effective management of long-term care and shift treatment goals to focus on continuous disability reduction and quality-of-life maintenance was observed. However, palliative care remained an undeveloped concept within Serbia and end-of-life services were largely acute, curative interventions delivered in hospital settings.
Strong grassroots advocacy efforts persuaded the Ministry of Health to establish the Palliative Care Task Force in 2004 and subsequently to develop the National Palliative Care Strategy. An early conference on palliative care organized by the Palliative Care Task Force was instrumental in driving change; the conference united stakeholders, created a tipping point for political buy-in and provided information to guide policy development. The National Strategy for Palliative Care was adopted in March 2009 and the Ministry of Health secured €4.1 million in EU funds to support its implementation. The subsequent EU-funded project (Development of Palliative Care Services in the Republic of Serbia) took place between March 2011 and November 2014, supporting the establishment of palliative care units across the country and providing 52 vehicles to facilitate delivery of home-care services. Funding also supported the strengthening of providers’ competencies through ad hoc trainings, which helped instil a new palliative philosophy among providers and root palliative services into the basic package of care. Palliative care training is now incorporated into formal medical education and specialized palliative care provider profiles have been introduced. Legislation was enacted to officially recognize NGOs and charitable organizations as actors in palliative care, allowing involvement of these organizations in service delivery. Palliative services are available across care levels, with increasing emphasis placed on providing care in community settings. Palliative services now offered include pain and symptom management, counselling, mental health services and occupational therapy. Social services, while already integrated within the health system, have been expanded in scope to better complement palliative care; for example, through the addition of bereavement and support services for informal caregivers.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
Motivation of an individual health provider to address observed challenges resulting from a lack of palliative care led them to seek out training in palliative medicine and establish the charitable organization, BELhospice, to obtain greater legitimacy and authority with policy-makers. Through advocacy efforts, this provider successfully brought the need for palliative care to the attention of policy-makers and joined the government’s newly-formed Palliative Care Task Force to influence change. The Palliative Care Task Force led the development of palliative care in Serbia, along with cross-ministry support and assistance from the EU-funded Development of Palliative Care Services in the Republic of Serbia Project. Providers’ willingness to apply new palliative care training allowed the palliative philosophy to sustainably embed itself within professional practice at the delivery level.
Formal evaluation of the intervention has not yet taken place. The initiative is believed by leaders to have strengthened delivery of end-of-life care in Serbia.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Natasa Milicevic
- Centre for Palliative Care and Palliative Medicine