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Friday, December 27, 2013

Merry Christmas and a Happy and Prosperous New Year!

On behalf of the past and future Presidencies and the Executive Committee  of the SEE Health Network

Dear Members and Partners of the SEE Health Network,
Dear Public Health Professionals from the 10 Countries, members of the SEE Health Network,
Dear Friends from all over the world,

The SEE Health Network Presidencies of Moldova and Montenegro in 2013 and the coming Presidency of Romania as of 01 January 2014, as well as the Executive Committee are pleased to present to all of you our best and most sincere Seasons Greetings and to wish you a very healthy, happy and prosperous New Year!

May you and your beloved ones are blessed!

May the regional and global collaboration for the health and well-being of the people in our countries, as well as in every single country globally, continue, become even stronger and contribute to achieving our goal, a better health for all citizens!

The Executive Committee expresses its gratitude and recognition to the Ministers of Health, the National Health Coordinators,  the nine SEE Regional Health Development Centres and all health system and public health experts from Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Israel, Republic of Macedonia, Republic of Moldova, Montenegro, Romania and the Republic of Serbia for their dedicated and high quality work through the mechanisms of the regional collaboration and the SEEHN.

2013 was a difficult year for us but was extremely successful and proved  maturity to a level that is unprecedented!

Our special thanks go to the Ministers of Health of the Republic of Moldova and Montenegro for the excellent Presidencies during which the Network completed enormous amount of work and achieved a result that is historical!

For the first time in our history health took its deserved position and became a part of the regional SEE 2020 Growth Strategy endorsed on 22 November by the SEE Investment Forum and the Regional Cooperation Council (RCC) in Sarajevo, Bosnia and Herzegovina.

We would like to thank with all our hearts the RCC for their continuous and solid support!

Last but not least, our gratitude goes to the Council of Europe and WHO Regional Office for Europe, our founding and true partners since 2001, the onset of the SEEHN.

Finally, we will not have been able to do so much without the continuous collaboration and support of the European Commission TAIEX Instrument for which we express our highest appreciation.

It is time to rest, enjoy the holidays with our beloved ones and to re-charge our energy, motivation, dedication and true friendship for a new start in 2014!

Cheers and have the most joyful and merry New Year!

Maria Ruseva
On behalf of the SEEHN Executive Committee

The very last and best present for the SEE Health Network in 2013: the new Website of the SEE Regional Health Development Center on Communicable Diseases Surveillance and Control is live!

Dear Friends from the SEE Health Network and beyond,

The Executive Committee of the SEE Health Network (SEEHN) is pleased and proud to inform you that a new Website on Communicable Diseases Surveillance and Control in the SEE region and the ten countries, members of the SEEHN, is already launched and is live!

The Executive Committee expresses its gratitude and most sincere recognition for this excellent work, achievement and present to us all to Dr. Silvi Bino and her team at the SEE Regional Health Development Center in Tirana, Albania called officially SECID!

The South East Europe Network on Infectious Diseases (SECID)  is already a legally independent entity and is still a part of the SEEHN.

We are also proud that our SECID is amongst the six founding Networks of the Global Network CORDS!

Congratulations and all the best in your endeavors and regional collaboration in the future!

We kindly invite All who will be interested to visit and follow the site at the following link:

The last SEE Health Network Event in 2013: EC TAIEX Workshop on Patients Safety, Belgrade, 16/17 December 2013

To learn all about the Last SEE Health Network event in 2013 please visit the website of the SEE Regional Health Development Center on Accreditation and Quality of Health Services at the link below:

Wednesday, December 11, 2013

Extraordinary success: the 32nd Plenary Meeting of the SEE Health Network and the SEE 2020 Growth Startegy

The 32nd Plenary Meeting of the SEE Health Network (SEEHN) recently finished its work in Podgorca, Montenegro under the Presidency of the Montenegrin Minister of Health, Prof. Dr. Miodrag Radunovic.

The SEEHN sincerely thanks and greets the Montenegrin Presidency  and the team of the Ministry of Health and the SEE RHDC for Noncommunicable Diseases for their excellent leadership and work in the period 01 July - 31 December 2013.

The SEEHN expresses its deep gratitude to its founding partner, WHO Regional Office for Europe and its Regional Director. At the 32nd Plenary WHO Europe was represented by Directors of its two important Divisions, those of Health Systems and Public health and of Noncommunicable Diseases and Health Promotion, who were accompanied by a few other senior leading technical experts.

During the event the SEEHN acknowledged and celebrated its best achievement in the past years since its 3rd Health Ministerail Forum, 2011, Banja Luka, Bosnja and Herzegovina, namely

the  SEE 2020 Growth Strategy, endorsed by the SEE Economy Ministers, under the leadership of Bosnia and Herzegovina and the Regional Cooperation Council (RCC) in Sarajevo.

For the first time in the history of the region and its cooperation in health, HEALTH has been recognized as a factor/determinant contributing to growth, economic development and wealth!

This is unprecedended fact and the SEEHN would like to express its gratitude, recognition and appreciations of:
  • all SEEHN political and leading experts for the intensive work in 2013, their motivation, dedication and contribution; thank you all; our most sincere and warm feelings go fo Selma, Adriana, Goran, Nand, Alex, Chris, Maria and all national counterparts and Directors of the SEE regional Health Development Centres (RHDC) in charge of the verious areas of health and health systems collaboration;
  • the RCC and its political and technical leadership; and
  • our best-ever friend and partner, WHO Regional Office for Europe and all poltical and technical leaders!
The SEE 2020 Growth Strategy has, for the first time, a chapter on Health, as a part of the inclusive Growth Pillar. There, based on global, European and own SEEHN evidence, for the first time there are health goals and targets, four strategic objectives and measures for implementation till 2020.

During a session, specially dedicated to the SEE 2020 Strategy and Health:
  • In a keynote speech, Sir Harry Burns, Chief Medical Officer of Scotland presented the Scottish Experience of Applying Inclusion Science to policies for improving Health and Growth, by retracing the economic turmoil in Scotland post WWII and its devastating impact on health. With Scotland acquiring decision powers in the health area, the health situation started to improve significantly and statistically corroborated (significant mortality reduction – people must feel in control and have access to support. For a change to come there must be a will, ideas and methods. While science must prevail over opinions, however dreams and visions are necessary – “I like my bedtime stories, it helps me to dream”.
  •  “Overview and implementation of the SEE 2020 Strategy”: Mr. Shani, RCC summarized this very important document, just signed by the Ministers of Economy of SEE in Sarajevo in November, it is a strategy on the way to the EU. Its focus on smart, integrated, sustainable and inclusive growth with a key health component, recognized as central for the first time – it is to be viewed as governance for growth – both centralized and decentralized actions are foreseen in four health components of pillar 4 – Inclusive Growth. Furthermore a monitoring mechanism is incorporated. 
  • “Health Actions in SEE2020 – Objectives and Indicators for inclusive growth”: Professor Sogoric, Member of the SEEHN Executive Committee spelled out the challenges facing Health in SEE: quality of care, poor or not known; lack of continuity of care; reduced function of primary care, unsustainable funding. There is a need in the Region to reduce differences of health status of population groups by increasing the health status of the most deprived. Increasng the management and capacity of health care (including human resources) is required. The main challenges of the health systems in the Region: - accessibility; increased efficacy; maintenance of costs. There is also the need to improve intersectoral governance and harmonization of cross border health.
  • These approaches were also supported by Dr. Chris Brown (WHO-Venice) and Romania (the upcoming Presidency of the SEEHN). Health in becoming a benefit and not a cost to the economy will emerge as a significant component for development.
  • The programming document to be elaborated  as soon as possible by the SEEHN is to be “A SEEHN health focused strategy document for inclusive growth independent of funding sources

Besides that extraordinary achievement, the 32nd Plenary Meeting focused on:

Partnership building with other organizations in health and related areas

MoU was signed with the United Nations Population Fund (UNFPA) represented by Ms. Doina Bologa, who presented the activities of the Fund and its cooperation with a large number of other UN Agencies, stressing the issue of population dynamics – in particular significant aging of the population in SEE.

The activities of the European Centre for Peace and Dialogue (ECPD) were also presented. A number of NHC supported the establishment of a partnership – agreed in principle. The meeting concluded that the terms of reference and the object of a possible MoU have to be clarified by the Executive Committee for a decision at the next SEEHN meeting.

Montenegro Presidency Report

Dr. Gauden Galea, WHO Europe Director, Division of Noncommunicable Diseases (NCD)  and  Health Promotion, presented an overview of the achievements in the countries of the SEEHN in a keynote speech. Plans for addressing NCD have been adopted in all the countries of the Network, often in collaboration with sectors other than health, with clear targets and indicators; all the countries have self-reporting surveys. However how decisions and data are used for action implementation is often not clear. The case of tobacco consumption was singled out as an example – highest ratification of the WHO Framework Convention on Tobacco Control and highest use of tobacco in the Region.

The Presidency highlighted the SEEHN achievements during the second half of 2013 in an extensive report. The SEEHN has entered its second decade, with a clear commitment as a Network and Member Countries to take responsibility for the further development of partnerships and institution networks; it has started working on its health strategy 2020 with the purpose to ensure a longer-term vision and perspective in public health development in the region. During this period WHO Europe extended its support to the Secretariat of the SEEHN in Skopje.

SEEHN Secretariat and Funding

The countries that have not yet paid their 2013 contributions to the SEEHN were urged to do so urgently.

Macedonia will put additional effort to finalize its obligation which it has undertaken to provide adequate and appropriate working space and facilities form the Secretariat of the SEEHN, and it was urged to do so as soon as possible; it was thanked for its continued staff secondment to the Secretariat.

Secretariat has been asked to prepare financial report (related to the SEEHN funds received and spent in 2013) to be sent, accompanied by a letter, to  the SEEHN member states.

The meeting approved in principle the terms of reference for the recruitment of the staff for the Secretariat – minor suggestions can still be submitted to the Secretariat until December 6, 2013, then the call for candidatures will be published, with the aim for the SEEHN to finalize the selection of Secretariat staff at the June meeting of the SEEHN. A selection committee will be composed of: 2 WHO Staff, 1 from each SEEHN MS - Croatia, Macedonia and Israel, 2 of the co-opted members from the Executive Committee of the SEEHN. The working selection method will be that of WHO. The Selection Committee will propose its list to the SEEHN one month in advance of the June 2014 plenary for decision.
RHDC Reports and Operation

The work programme for the RHDC on NCD in Montenegro was presented by its Director to the SEEHN. It will be reviewed by the Executive Committee, with input requests from the SEEHN Members, for a Decision at the next SEEHN meeting.
The work of all 9 RHDC was presented, discussed and highly acknowledged. The leadership of the respective countries, hosting the RHDC, in the various public health and health systems areas of technical collaboration is to be commended. The Meeting expressed special gratitude to Albania, Bosnia and Herzegovina, Croatia, and the Republics of Moldova and Serbia in that regards.

The full texts of the reports of the SEE RHDCs are available at request with the SEEHN Executive Committee at .

Furthermore a special meeting of the SEEHN NHC and of the Directors of the RHDC is to be organized prior to the next SEEHN plenary meeting to propose Operational Procedures for the RHDCs.

Roadmap for the 2014 (first half) Romanian Presidency of the SEEHN

The detailed roadmap was presented and well received. Additional comments and suggestions may be submitted to Romania by the end of the year, for Romania to adjust its plan if appropriate. The full text of the Romanian Presidency Roadmap is presented in Annex ….

TAIEX Workshop outcome and Draft Network Decision on Preventive Actions Against Excessive Salt Intake

The outcome of the TAIEX Workshop was presented by the Rapporteur (Dr. Alexandre Berlin) together with a draft Decision for the SEEHN. Preliminary reactions were very positive; minor adjustments are still possible until December 6 (to be submitted to the Rapporteurs – Dr. Berlin and Dr. Ruseva. The Decision will be then signed by the Montenegro President of the SEEHN. The draft Decision is enclosed in Annex … .

TAIEX 2014 Events

The SEEHN was informed again of the TAIEX requirement for 2014 to submit to them by early January a proposed list of SEEHN events for their consideration with for each proposed event:
·         title and object;
·         nature (workshop, study visit; expert mission);
·         specific Acquis Communautaire;
·         expected outcome
·         length -half page total.
Each proposal is to be sent to Alexandre Berlin and Maria Ruseva, as well as the Chair of the SEEHN Executive Committee by December 17, 2013. An agreed list of up to 8 events will be prepared and submitted to TAIEX for their preliminary consideration.

On 28th November, the Council of Europe, the other founding partner of the SEEHN, had a special event.
Please follow us! News on it will come in our next post!






Monday, December 9, 2013

Aiming at concrete results: The first SEE Regional Workshop on Antimicrobial Resistance took place in Sofia, Bulgaria, 29-30 November 2013

The first SEE Regional Meeting took place in Sofia and was organized by the Bulgarian
Ministry of Health to address the issue of antibiotic resistance in its through the SEE Health Network  (SEEHN) designated  Regional Health Development Center (RHDC).
The RHDC is hosted by the National Centre of Infectious and Parasitic Diseases (NCIPD) which is under the Ministry of Health. It builds on the existing institutional, human and technical resources of the NCIPD in line with the Memorandum of Understanding on the future of the SEEHN and the plan for establishment and development of the RHDCs in the SEEHN member states.

The purpose of the event was to bring together all focal points on antibiotic resistance of the 10 SEEHN member-states and to convene a 1,5 days discussions on the most important issue of antibiotic resistance surveillance in the SEE region. The meeting was also attended by a representative of Turkey as an affiliated to the SEEHN for this special meeting. The National Centre of Infectious and Parasitic Diseases used to have a long standing collaboration with the Public Health Institute of Turkey and their participation was valuable and beneficial for the future partnerships of the RHDC.The meeting was also attended by the representatives of some of the regions in Bulgaria who participate in the national BULSTAR surveillance system of AMR.

During this first meeting, the participants (focal points on antibiotic resistance of the 9 SEEHN countries) together with the nationals from the regions had the opportunity to discuss different important issues and problems faced by the countries and related to future plan of work of the SEEHN RHDC on antibiotic resistance. The participants received a disc with all important official documents related to the establishment and functioning of the SEEHN: MoU, Decision on the establishment of RHDCs and Host Agreement.

A special Questionnaire - SELF-ASSESSMENT SURVEY ON ANTIMICROBIAL RESISTANCE was prepared by the SEE RHDC in advance and sent to all focal points. The questionnaire was based on the WHO EURO documents and builds upon the strategic objectives of the European Strategic Action Plan on Antimicrobial Resistance. The data received have been processed by the SEE RHDC, reported and discussed during the meeting. Some recommendations for further implementation of the objectives of the European Strategic Action Plan on Antimicrobial Resistance have been made.

The most significant 5 bacterial pathogens in hospitals in the region are:  Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii, Escherichia coli, Enterococcus faecium; and in ambulatory care are: Escherichia coli, Staphylococcus aureus , Streptococcus pneumonia, Klebsiella pneumoniae, Enterococcus faecium.
The main causes of drug resistance were determined as overuse of antibiotics, use of drugs without reasonable indications, inadequate infection control and stewardship of antibiotic use in health care settings, insufficient practical education on antibiotic use during undergraduate education, uncontrollable use of antibiotics in animal sector, imperfect laboratory diagnosis, lack of adequate therapeutic guides, lack of awareness of the general population, inappropriate  dose and duration of treatment and the absence of systematic monitoring of drug use in the medical, veterinary and food industries.
All countries have national focal point for antimicrobial resistance. Only three of them (Croatia, Macedonia and Montenegro) have functional national coordinating committee on antimicrobials/AMR. All countries have reference laboratories. BiH Federation/BIH and the Republic of Moldova are in process of establishment. There are reports for MRSA, carbapenemases, PNSSP, VRE, but not for ESBL in 3 countries (Croatia, Republic of Moldova and the Republic of Serbia).  All countries use for detection of AMR phenotype methods, determination of MIC and genetic methods.

Most countries celebrate the European Antibiotic Awareness Day. They have different activities. In all countries doctors, hospital health care workers, community health care workers have some education on AMR, as part of their general education, but there isn’t enough specific educational programs in this field.

The experience of Bulgaria:
The Antibiotic Resistance Surveillance System in Bulgaria BULSTAR which started in 1997 was discussed on a large scale, with emphasis on the standardization of laboratory methods through internal and external quality assessment system, monitored materials from in-patient and out-patient health establishments, most frequently isolated microorganisms in different materials, etc.

The resistance to 30 antibiotics is reported annually on central level to the central reference laboratory of the National Center on Infectious and Parasitic Diseases. The system covers the whole territory of the country comprising of 166 microbiological labs. Out of 38 505 hospital beds the system covers 22 812 hospital beds. 70 private labs are also participating in the system, responsible for out-patient health establishments. The data received are supportive for developing therapeutic guidelines and hospital policies for coping with antibiotic resistance. The pharmaceutical companies in Bulgaria also use these data.

Although the antibiotic consumption in Bulgaria for 2008-2010 is 24,6-22,5 DDDs per 1000 population per day, the antibiotic resistance is increasing. The main reason for this is the overuse and misuse of cephalosporin’s followed by penicillin’s alone and in combination with inhibitors. Resistance to Gram-negative bacteria such as Escherichia coli and Klebsiella pneumonia is rapidly increasing in Bulgaria too. During the last five years the production of ESBLs has doubled in hospital settings. Resistance to methicillin by Staphylococcus aureus (MRSA) in total is 10% while the invasive resistance is much higher. The issue of reduction in the prevalence of antibiotic resistance by addressing the use, overuse and misuse of antibiotics in all sectors such as: health care, veterinary and agricultural settings, etc. is also a priority for Bulgaria. Preliminary discussions on inter-sectorial level have been carried out but the results are not promising.

The presentations given by the Focal Points of Bosnia and Herzegovina,  Croatia, Israel, Montenegro, republic of Macedonia, Republic of Moldova and the Republic of Serbia on the current situation of AMR delineated some interesting and debatable issues characteristic for all countries: policy development, updating of legislation, networking, establishment of inter-sectorial coordination mechanism at ministerial level, improvement of communication between sectors, rational use of antibiotics, standardization of methods, internal and external quality assessment systems, data management, training of professionals and capacity building in management, lack or insufficient guidelines in some countries, surveillance system in one country (Montenegro) not in place, growing awareness to nosocomial infections, high expenses of some tests and related financial pressure posed on microbiologists from hospital directors, streamlining of expenses, overuse of broad specter antibiotics related to some extend to their lower price compared to narrow specter antibiotics (first and second generation cephalosporin’s), involvement of private sector on larger scale, targeting general public on permanent basis, constant awareness campaigns for different target groups,

The representative of Turkey also gave a short presentation. Turkey started their surveillance system of antibiotic resistance three years ago. They have approximately the same problems as the SEEHN member-states. They are eager to share their data during the next meeting of the Network.

During the meeting the following topics associated with antibiotic resistance surveillance system, introduced by the Bulgarian professionals of the RHDC, were discussed by participants:
·         Communicable disease surveillance system  in Bulgaria
·         Epidemiology and antifungal susceptibility of clinically significant fungi
·         Advances in molecular surveillance of healthcarе associated infections in Bulgaria
·        Phenotypic methods for routine detection of antibiotic resistance mechanisms in Gram negative bacteria: the experience of a cancer hospital in Bulgaria
·        Antimicrobial susceptibility of human extra-intestinal non-typhoid Salmonella isolates in Bulgaria, 2005-2012
·         Current and emerging mechanisms of antimicrobial resistance in Bulgaria
·         TB Surveilance in Bulgaria
·         Characterization of methicillin-resistant Staphylococcus aureus isolated in Bulgaria
·         The relationship between antibiotic consumption and antimicrobial drug resistance - general concepts
·         COMBACTE network and research opportunities on the Balkans

Information on the specialty of microbiology in the SEEHN countries has been exchanged.

In some countries like Israel the specialization differs for doctors and biologists which is the American model. In Europe it is different. The specialty of clinical immunology was also raised and information exchanged.

The participants of the meeting reached a common opinion that the establishment of an inter-sectorial coordinating mechanism for antibiotic resistance surveillance at ministerial level is essential.

The possibilities for collaboration and future work have been discussed at the end of the meeting, namely:

  1. Approaching TAIEX on behalf of Macedonia or eventually another SEEHN country for organizing the next meeting of the Focal Points of RHDC based on the Draft Decision on the collaboration between SEEHN and EC/TAIEX in 2014 approved during the 32nd Plenary Meeting of the SEE Health Network in Podgorica, Montenegro, November 2013.
  2. Mutual work of all member-states for preparation of educational programs for medical doctors, hospital health care workers, and community health care workers. 



Tuesday, December 3, 2013

WHO/Europe | Media centre - Fact sheets

WHO/Europe | Media centre - Fact sheets

WHO/Europe | Media centre - Tackling cancer, cardiovascular diseases and diabetes in 53 countries: health ministers meet in Ashgabat,Turkmenistan

WHO/Europe | Media centre - Tackling cancer, cardiovascular diseases and diabetes in 53 countries: health ministers meet in Ashgabat,Turkmenistan

WHO/Europe | Ashgabat conference on noncommunicable diseases - Speakers and senator group

WHO/Europe | Ashgabat conference on noncommunicable diseases - Speakers and senator group

WHO/Europe | Ashgabat conference on noncommunicable diseases - Video – Ruth Weinstein, Director, Department of Health Promotion, Ministry of Health, Israel

WHO/Europe | Ashgabat conference on noncommunicable diseases - Video – Ruth Weinstein, Director, Department of Health Promotion, Ministry of Health, Israel

WHO/Europe | Ashgabat conference on noncommunicable diseases - Video – Fiona Godlee, Editor in Chief, “BMJ”

WHO/Europe | Ashgabat conference on noncommunicable diseases - Video – Fiona Godlee, Editor in Chief, “BMJ”

WHO/Europe | Ashgabat conference on noncommunicable diseases - Video – Clive Needle, Director of EuroHealthNet on the fight against NCDs

WHO/Europe | Ashgabat conference on noncommunicable diseases - Video – Clive Needle, Director of EuroHealthNet on the fight against NCDs