JAVNOZDRAVSTVENI RADNICI: KO SU, ŠTA RADE, ZNAČAJ I IZAZOVI
Sažetak
Bez angažovanja profesionalaca, koji čine javnozdravstvenu radnu snagu odgovornu za upravljanje, koordinaciju i pružanje osnovnih javnozdravstvenih usluga, ne bi mogao biti postignut dramatični napredak javnog zdravlja u 20. veku povezan sa produženjem očekivanog trajanja životnog veka i unapređenjem kvaliteta života, smanjenjem smrtnosti odojčadi i dece, smanjenjem i eliminacijom brojnih zaraznih bolesti. U sisteme javnog zdravlja u zemljama širom sveta, uključujući i Republiku Srbiju, „hronično“ se nedovoljno ulaže, te se isti suočavaju sa poteškoćama da obezbede adekvatan broj i odgovarajuću distribuciju kvalifikovanih javnozdravstvenih radnika. Brojni izazovi u vezi sa javnozdravstvenom radnom snagom mogu se sagledati kroz podelu na: društvene (starenje radnika, niska atraktivnost profesije, nizak moral i motivacija, izazovi zadržavanja), tehnološke (heterogena ponuda obrazovanja i obuke, nedostatak mogućnosti za profesionalni razvoj), ekonomske (nedovoljno finansiranje i niske plate), ekološke (antibiotska rezistencija, zagađenje, bezbednost hrane, klimatske promene, urbanizacija), političke (niska pozicija na listi prioriteta političkih lidera, nedostatak pravnih i zakonskih okvira za razvoj radne snage) i pravne i etičke (nedostatak jasno formulisanog etičkog kodeksa u javnom zdravlju). Za pružanje visokokvalitetnih javnozdravstvenih usluga, smanjenje zdravstvenih nejednakosti i adekvatan odgovor na nove izazove javnog zdravlja neophodno je unapređenje kapaciteta kvalifikovane i kompetentne radne snage kroz dobro razumevanje interesa i potreba javnozdravstvenih radnika, svrsishodno planiranje sukcesije, zapošljavanje i zadržavanje radnika i efikasnije raspolaganje resursima. Sveobuhvatno sagledavanje upravljanja javnozdravstvenim kadrovima, kao i kreiranje strateških i operativnih kadrovskih politika u zdravstvenom sistemu Republike Srbije neophodni su da bi se odgovorilo na zahteve koje donose krizne situacije, kakva je pandemija nove zarazne bolesti.
Reference
Babić M, Bjegović Mikanović V, Vuković D i sar. Literatura. In: Simić S, editor. Socijalna medicina. Udžbenik za studente medicine. Beograd: Medicinski fakultet Beograd; 2012.
Azari R, Borisch B. What is public health? a scoping review. Arch Public Health, 2023. 81; 86. https://doi.org/10.1186/s13690-023-01091-6.
Acheson D. Public health in England. The report of the committee of inquiry into the future development of the public health function. London: HMSO; 1988.
Bjegovic Mikanovic V, Czabanowska K, Flahault A et al. Addressing needs in the public health workforce in Europe. Copenhagen: World Health Organization; 2014. http://dx.doi.org/10.13140/2.1.2707.0407.
Rotem A, Walters J, Dewdney J. The public health workforce education and training study. Aust J Public Health. 1995; 19(5):437-8. doi: 10.1111/j.1753-6405.1995.tb00404.x.
Beaglehole R, Dal Poz М. Public health workforce: challenges and policy issues. Human Resources for Health. 2003; 1(1):4.
Institute of Medicine (IOM). Shaping the Future: Who will keep the public healthy? Educating public health professionals for the 21st century. 2002.
Whitfield M. Public health job market. In Employment in Public Health in Europe [Zatrudnienie w Zdrowiu Publicznym w Europie]. K. Czabanowska and C. W lodarczyk, Eds. Kraków, Jagiellonian University Press. 2004.
WHO Regional Office for Europe. European Action Plan for Strengthening Public Health Capacities and Services. Copenhagen: WHO Regional Office for Europe, 2012. Dostupno na: http://www.euro.who.int/en/health-topics/Health-systems/public-health-services/publications/2012/european-action-plan-for-strengthening-public-health-capacities-and-services.
National workforce capacity to implement the essential public health functions including a focus on emergency preparedness and response: action plan (2022–2024) for aligning WHO and partner contributions. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
Watts RD, Bowles DC, Ryan E et al. No Two Workforces Are the Same: A Systematic Review of Enumerations and Definitions of Public Health Workforces. Front. Public Health. 2020; 8:588092. doi: 10.3389/fpubh.2020.588092.
Zhang Y, McDarby G, Seifeldin R et al. Towards applying the essential public health functions for building health systems resilience: A renewed list and key enablers for operationalization. Front. Public Health, 2023; 10:1107192. doi: 10.3389/fpubh.2022.1107192.
Institute of Medicine (IOM). The Future of Public Health. Washington, DC: National Academy Press; 1988.
CDC. The Essential Public Health Services. Dostupno na: https://www.cdc.gov/publichealthgateway/publichealthservices/originalessentialhealthservices.html.
WHO. Essential Public Health Functions: Results of the International Delphi Study. World Health Statistics. 1998; 51.
Essential public health functions, health systems and health security: developing conceptual clarity and a WHO roadmap for action. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.
World Health Organization. Regional Office for Europe. Self-assessment tool for the evaluation of essential public health operations in the WHO European Region. World Health Organization. Regional Office for Europe; 2015. Dostupno na: https://apps.who.int/iris/handle/10665/344398.
World Health Organization. Regional Office for Europe. Health 2020: a European policy framework and strategy for the 21st century. World Health Organization. Regional Office for Europe; 2013. Dostupno na: https://apps.who.int/iris/handle/10665/326386.
Regional Committee for Europe, 62nd session. Sixty-second Regional Committee for Europe: Malta, 10–13 September 2012: report of the sixty-second session of the WHO Regional Committee for Europe. World Health Organization. Regional Office for Europe; 2012. Dostupno na: https://apps.who.int/iris/handle/10665/336532.
WHA69.1 Strengthening essential public health functions in support of the achievement of universal health coverage. Geneva: World Health Organization; 2016. Dostupno na: https://apps.who.int/iris/handle/10665/252781
21st century health challenges: can the essential public health functions make a difference? Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
National workforce capacity to implement the essential public health functions including a focus on emergency preparedness and response: roadmap for aligning WHO and partner contributions. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
The European Health Report 2021. Taking stock of the health-related Sustainable Development Goals in the COVID-19 era with a focus on leaving no one behind. Copenhagen: WHO Regional Office for Europe; 2022. Licence: CC BY-NC-SA 3.0 IGO.
WHO Regional Office for Europe. Tuberculosis in the WHO European Region - Factsheet [website]. Copenhagen: WHO Regional Office for Europe; 2021. Dostupno na: https://iris.who.int/bitstream/handle/10665/340277/WHO-EURO-2021-1980-41731-57122-eng.pdf?sequence=1.
Rome Declaration. European Union; 2021. Dostupno na: https://global-health-summit.europa.eu/rome-declaration_en.
G20 Italia. Declaration of G20 Health Ministers; 2021. Dostupno na: https://www.g20.org/wpcontent/uploads/2021/09/G20_Italia_2021_Health_Declaration_final_05092021_OFFICIAL.pdf.
Yeager VA, Wisniewski JW, Amos K, Bialek R. Why Do People Work in Public Health? Exploring Recruitment and Retention Among Public Health Workers. J Public Health Management Practice. 2016;00(00):1–8.
Roadmap to professionalizing the public health workforce in the European Region. Copenhagen: WHO Regional Office for Europe; 2022. Licence: CC BY-NC-SA 3.0 IGO.
Bjegovic-Mikanovic V, Santric-Milicevic M, Cichowska A et al. Sustaining success: aligning the public health workforce in South-Eastern Europe with strategic public health priorities. Int J Public Health. 2018; 63(5):651-662. doi: 10.1007/s00038-018-1105-7.
WHO Regional Office for Europe. WHO-ASPHER Competency Framework for the Public Health Workforce in the European Region [website]. Copenhagen: WHO Regional Office for Europe; 2020. Dostupno na: https://www.euro.who.int/en/health-topics/Health-systems/public-health-services/publications/2020/who-aspher-competency-framework-for-the-public-health-workforce-in-the-european-region-2020.
World Health Organization. Regional Office for Europe, European Observatory on Health Systems and Policies, Bjegovic-Mikanovic, Vesna, Vasic, Milena, Vukovic, Dejana. et al. 2019. Serbia: health system review. World Health Organization. Regional Office for Europe.
Zakon o zdravstvenoj zaštiti. "Službeni glasnik RS", br. 25/2019 i 92/2023.
Zakon o javnom zdravlju. "Službeni glasnik RS", br. 15/2016.
Zakon o zdravstvenom osiguranju. "Službeni glasnik RS", br. 25/2019 i 92/2023.
Uredba o planu mreže zdravstvenih ustanova. "Službeni glasnik RS", br. 5/2020, 11/2020, 52/2020, 88/2020, 62/2021, 69/2021, 74/2021, 95/2021, 43/2023, 58/2023, 87/2023 i 103/2023.
Pravilnik o specijalizacijama i užim specijalizacijama zdravstvenih radnika i zdravstvenih saradnika. "Službeni glasnik RS", br. 10/2013, 91/2013, 113/2013, 109/2014, 53/2018, 17/202, 77/2022, 6/2023 i 93/2023.
Pravilnik o bližim uslovima za obavljanje zdravstvene delatnosti u zdravstvenim ustanovama i drugim oblicima zdravstvene službe. "Službeni glasnik RS", br. 43/2006, 112/2009, 50/2010, 79/2011, 10/2012, 119/2012, 22/2013, 16/2018, 18/2022 i 20/2023.
Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“. Zdravstveno-statistički godišnjak Republike Srbije 2022. Beograd: Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“; 2023.
Republika Srbija. Republički zavod za statistiku. Izveštaj o napretku u ostvarivanju ciljeva održivog razvoja do 2030. godine u Republici Srbiji. Izveštaj za 2022. godinu. Beograd: Republički zavod za statistiku; 2023.
Republički zavod za statistiku i UNICEF. Istraživanje višestrukih pokazatelja položaja žena i dece u Srbiji i Istraživanje višestrukih pokazatelja položaja žena i dece u romskim naseljima u Srbiji, 2019, Izveštaj o nalazima istraživanja. Beograd, Srbija: Republički zavod za statistiku i UNICEF.
Republički zavod za statistiku. Становништво - Процене становништва. Beograd: Republički zavod za statistiku; 2023. Dostupno na: https://publikacije.stat.gov.rs/G2023/Html/G20231179.html.
Program unapređenja kontrole raka u Republici Srbiji za period 2020-2022. godine. "Službeni glasnik RS", br. 105/2020.
Marić N, Lazarević Lj, Knežević G i sar. Psihijatrijski poremećaji, distres i pandemija KOVID- 19 u Srbiji: Rezultati na nacionalno reprezentativnom uzorku. Beograd: Institut za mentalno zdravlje; 2022. Dostupno na: https://cov2soul.rs/o-projektu/#dearflip-df_100483/21/.
Republika Srbija. Ministarstvo zdravlja Republike Srbije. Republički zavod za statistiku. Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“. Istraživanje zdravlja stanovništva Srbije 2019. godine. Beograd: 2021.
Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije u 2022. godini. Beograd: Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“; 2023.
Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“. Zdravstveno-statistički godišnjak Republike Srbije 2021. Beograd: Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“; 2022.
Strategija javnog zdravlja u Republici Srbiji 2018–2026. godine. "Službeni glasnik RS", br. 61/2018.
Santric- Milicevic M, Vasic M, Edwards M et al. Strengthening the public health workforce: An estimation of the long-term requirements for public health specialists in Serbia. Health Policy, 2018; 122:674–680. https://doi.org/10.1016/j.healthpol.2018.03.012.
Tripkovic K, Santric- Milicevic M, Miladinovic- Mandic M et al. Implementation of theWorkload Indicators of Staffing Need (WISN) method in determining staff requirements in public health laboratories in Serbia. Disaster Med. Public Health Prep, 2020; 1–9. https://doi.org/10.1017/dmp.2020.133.
Tripković K. Ispitivanje faktora povezanih sa namerom javnozdravstvenih radnika u Republici Srbiji da promene posao. Doktorska disertacija. Medicinski fakultet Univerziteta u Beogradu, 2023.
Institut za javno zdravlje Srbije „Dr Milan Jovanović- Batut“. Nacionalni zdravstveni račun. Dostupno na: https://www.batut.org.rs/index.php?category_id=50.
Program rada SZO za Evropu u periodu 2020–2025. godine „Udružena akcija za bolje zdravlje u Evropi” Kopenhagen: Regionalna kancelarija SZO za Evropu; 2021. god., Licenca: CC BY-NC-SA 3.0 IGO.