Weaknesses of Community Healthcare System in Slovakia. Unequal Access to Primary and Community Healthcare Services. Minority Sensitive Healthcare Provision and Reception.
For most of us it comes naturally that if we need advice, guidance or to be examined by healthcare professionals, we simply arrange a consultation with our health care provider, and with a little luck we can visit them on the same day on which we expressed our interest in the consultation. Unfortunately, this statement does not apply to everyone. Based on the administrative data on Roma health outcome indicators prepared by the Institute of Financial Policy. It was revealed that the health status of the Roma population is significantly worse in comparison to the majority population (Institute of Financial Policy, 2018). Roma are at risk of obesity, diabetes, disorders of the cardiovascular system and different types of tumors, e.g. lung cancer, (Moricova et al., 2013).
However, solutions to this problem have long been known in the world of healthcare provision! One of considerable solution, is to strengthen the employment and professional activities of highly erudite nurses (advanced care nurse practitioners) in primary and community health care system. And why this category of nurses and not doctors? The answer is very easy! Nowadays according to common EU nurse´s education regulations all nursing students, candidates have to attend university or higher preparation programs in different university degree levels and in several specialization programs.
As otherwise nowadays the preparation process of nurses for clinical practice has changed. Currently gets much more attention their preparation in areas of health promotion, education, prevention, and knowledge building in autonomous works, especially in management of patients with acute and chronic disorders. Based on this change in roles of nurses the places of work of doctors have also changed, today we no longer need to have as many doctors in community practice as in the past. Physicians in countries with advanced health care systems can thus maximize their role and devote themselves to real comprehensive diagnostics and demanding medical procedures.
Expert opinions from the Strategy of the Slovak Republic for Roma Integration until 2020 clearly state that "insufficient determinants of the health status of Roma may be responsible for the determinants of their deteriorating health and social awareness" (Urad vlady SR, 2011). It is widely known that state institutions have long known about the problematic sphere of providing primary and community healthcare. (Urad vlady, 2011 p. 34) This situation ultimately arose as a result of systematic ignorance and lack of interest in solving the problematic area of the impaired access to healthcare services by public administration institutions. In this case, it is mainly the inactivity of state administration bodies such as Government of the Slovak Republic, the Ministry of Health and the Office of the Plenipotentiary of the Government for Roma Communities, and the low - level cooperation of these state institutions. What should be their priority in this case, as it is precisely the elements of health care such as health mediation, prevention, education and the provision of complex care to the individual in his, her s natural environment (Mikulickova and Mikulicka, 2016).
The fact that the lack of access to health care services of various levels (community - primary health care, specialized - secondary health care, including preventive health care and health education) can strongly affect the health of marginalized Roma, can be seen also in the latest strategic document of the Slovak government for Roma integration by 2020. (Urad vlady SR, 2011) ,where it is stated that “insufficient quality of provision has a direct impact on their health, quality of life as well as on overall life expectancy.
Which ultimately leads to much higher morbidity, mortality and deteriorating quality of life than in comparison with the state of health of the majority society” (p. 35). This problem area most severely affects citizens of the Roma national minority living in highly segregated and socially disadvantaged communities. The Roma community in this case is only one of the disadvantaged groups in terms of access to community healthcare services, whereas it also strongly affects elderly, chronically ill and disabled persons (Herianova, 2018).
Finding solutions to eliminate this long-standing problem of poor access of the Roma community to public health care services, as a subsequent implementation into the system, will require multi segmented cooperation and the responsibility of various state administration institutions. This is also pointed out by one of the most important WHO documents, which is: Health 21 - the health program for the European region in the 21st century. The document repeatedly points to the fact that the most pressing problems in receiving public health services must be a priority of various state institutions at the same time. (Ondriova, 2018) For the purposes of Slovak practice this situation calls for increasing of the mutual participation of different state institutions in the search for the most appropriate solutions. Based on this knowledge it is not conceivable for society and government to expect vigorous and lasting positive changes in this situation, e.g. only from the Office of the Government Plenipotentiary for the Roma Community or only from the Ministry of Health.
The uniqueness of the work of nurses in community nursing and its justification in the practice is becoming an increasingly discussed topic in Slovakia. The scope of work of nurses in community care also very aptly defines the following statement „the role of the nurse is to search for, monitor health risks, diagnose them, plan their elimination and subsequently develop interventions to support the health of citizens“ (p.33) (Gulasova et al., 2013) That is why it is high time to change our view of nurses as traditional nursing care providers and to focus our attention more on their activities in prevention and health promotion, which they can perform brilliantly in practice.
From the point of view of daily practice in Slovakia unfortunately I have to say, that still the leaders in the field of health care, have not come to the point of being fully aware of the benefits of provision health care services by nurses and their positive impact on society-wide health. This manifests itself in a certain non-acceptance of the autonomous care provided by highly erudite nurses. Consequently, in clinical practice it causes various blockades in the performance of some medical procedures and interventions limited by poorly set definitions of nurses competencies, which do not sufficiently reflect the real needs of the practice. This opinion is also voiced by the Slovak Chamber of Nurses and Midwives themselves, which commented on this area as follows: „nurses and midwives increasingly found themselves in situations where they had to exceed their legal powers in the interests of the patient“ (p. 1) (Slovak Chamber of Nurses and Midwives, 2017). From the point of view of the smooth running effectiveness of health care practice, we can talk about the following competencies, with which we need to expand the clinical powers of nurses: prescribing chronic pharmacotherapy, indicating a professional medical examination or the power of long-term motivation and guidance of patients with chronic diseases. Personally, I am more than convinced that it is these shortcomings in practice that complicate the process of receiving primary and community health care.
I think that these statements, as well as the actual clinical chaos, are sufficient indicators to launch a professional and public debate on promoting access to and acceptance of primary and community health care in Slovakia. A very good example of the fact that legislation for the benefit of citizens can be changed is the act of the National Council of Hungary in 2016, which changed the academic preparation and competencies of advanced care nurses based on positive foreign practice, which has a long tradition in the world of health care provision abroad. I am convinced that such an attitude in the legislative change in a very short time horizon must also be taken by the Slovak Republic.
Owing to the high professionalism of healthcare academics and the serious interest of politicians, Hungary has succeeded in partial stabilization of the reception of healthcare in various specialist areas of healthcare provision within a few years of the adoption of legislative changes aimed at strengthening the competences of nurses. Slovakia, now it is your turn! (National Council of Hungary, 2016).
Gulasova, Svecova, Breza, Hruska, Neumanova (2013, January 11). Zdravotne rizika v komunite. Bratislava, Slovakia, Slovakia, Bratislava. Retrieved from https://www.linkos.cz/lekar-a-multidisciplinarni-tym/kongresy/po-kongresu/databaze-tuzemskych-onkologickych-konferencnich-abstrakt/zdravotne-rizika-v-komunite/
Herianova, 2. (2018). Osetrovatelstvo v komunitnej starostlivosti. Bratislava: Slovenska zdravotnicka univerzita. doi:978-80-89702-56-5
Mikulickova and Mikulicka, 2. (2016). Osetrovatelstvo v komunite. Bratislava: Obcianske zdruzenie Elisabeth.
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Urad vlady SR, (2011, Decemeber). emloyment.gov.sk. Retrieved from https://www.employment.gov.sk/files/legislativa/dokumenty-zoznamy-pod/strategia-integracie-romov-do-roku-2020.pdf