Montenegro

Protecting patients’ rights in Montenegro: achievements and challenges

Podgorica, 9 December 2011

A series of measures has been undertaken lately in Montenegro aimed at improving the quality of health care and protecting of patients’ rights, including the appointment of ombudspersons in all health facilities. According to the Montenegrin Law on the rights of patients, it was prescribed that the health ombudsperson should be on the payroll of the institution against which complaints are being received. At a roundtable on protecting the rights of patients, President of the Associationfor the Protection of the Patients' Rights of the Republic of Croatia mr. sc. Đula Rušinović-Sunara said that protectors of the rights of patients should not be employed at the institution on whose account the patients complain. Assistant Minister of Health Dr. Jadranka Lakićević said that ombudspersons coming from the institution in which they work are common practice in many countries. The round table was organized on the occasion of International Anti-Corruption Day by the Ministry of Health and UNDP Montenegro.

The objective of the roundtable was to initiate a dialogue with appointed Ombudspersons, Ministry of Health, Medical Chamber of Montenegro and NGOs, as well as to provide ideas and generate drive and enthusiasm to move closer to equitable, quality health care, ultimately reducing occurrence of informal payments.

The round table “Patients’ rights protection – achievements and challenges“ is yet another step in a successful cooperation between the Ministry of Health, UNDP and the World Health Organization that started back in 2009 and resulted in research “The Integrity Assessment of the Health System in Montenegro”
The study indicated the significant presence of informal payments in the health care, thus hindering equitable access to quality medical services. As informal payments affect the most vulnerable social groups and represent important barrier to social inclusion, the study points to the need of empowering patients and raising public awareness about the work of ombudspersons and analyzing opportunities for improvement of existing solutions.

Ms. Rušinović-Sunara contributed to the discussion by assessing the input of heath sector ombudspersons to better quality health care. She indicated that ombudspersons should be given a license to work and a good salary and then be provided with an independent position within the health care system. ”We in the World Association for Medical Law do not agree that that work can be done by someone in a conflict of interest. The conflict of interest is the problem with all ombudspersons of the world that is not easy to solve, and it is about a political decision,“ she said, noting that „those who receive money from the Health Fund will not protect patients but themselves.“

Assistant Minister of Health Dr. Jadranka Lakićević said that ombudspersons coming from the institution in which they work are the case in many countries. „The ombudsperson comes from an institution where they know the work process and colleagues, where they can quickly and efficiently look into the situation, the details, facts and circumstances, why it happened, how it happened, and to come up with solutions to a problem through a quick conversation with the team to whom the complaint relates and with the director. What is particularly important is that the director be aware of complaints, because in this way it is easier to identify the weak links,“ she pointed out.

Ms. Rušinović-Sunara praised the efforts of Montenegrin health authorities to establish the institute of ombudsperson for patients’ rights. „Starting this kind of work is very commendable and positive. Of course, there is still a lot to do,“ she said, and added that in Croatia it began back in 2004. „Educating ombudspersons should come in the first place,“ advised Ms. Rušinović-Sunara to her Montenegrin colleagues, “in order to take a common position for the purpose of solving the problems of patients in the same manner.“

Ms. Lakićević said that during 2011ombudspersons received 396 complaints on medical services. Of these the largest number of complaints related to primary care and the work of community health centers, 206, for the secondary level was 49, the tertiary 131, while 10 patients complained about the emergency room. She said that the largest number of complaints related to inadequate communication between health workers and patients, hostility, long waiting time for some diagnostic and therapeutic procedures, as well as the quality of health services.

Ms. Radmila Stupar-Đurišić from the Montenegrin Patients’ Rights Protection Association informed the gathering that the association has been active for the past two years. This NGO, relying on its network of 350 volunteers, received 800 complaints over the course of two years which have been resolved in mediation with the medical staff in question.  

Ombudsman at the Clinical Center of Montenegro Mr. Momčilo Jovović said that during this year there were about 140 complaints on the work of this institution. Most of them, almost half were related to long waiting times for check-ups and diagnostics, while complaints of unkind medical staff are in the second place. „These complaints have occurred in about 15-20 percent of the total number of complaints, which we consider a significant number. A percentage of complaints was related to obtaining information by phone, and a very small percentage ranging from one to two percent referred to the incompetence of doctors,“ said Mr. Jovović, and noted that more than 95 percent of complaints were resolved.

“We did not get any reports of corruption,“ said also Mr. Jovović, pointing out that sanctions have been taken regarding unkindness of medical staff. He thinks that, in relation to the number of check-ups that are done at the Clinical Center, the number of complaints is small and that the quality of work is good. At the Health Center Berane, according to the ombudsman in that institution, Mr. Ranko Raketić, during the year there were only 13 complaints, of which ten, i. e. 80 % accounted for the unsatisfactory behavior of health workers, while the remaining ones relate to the quality of work and waiting for check-ups or diagnostics.

The discussion during the roundtable also addressed the fact that globalization of the health system is essential if the intention is to protect patients from adverse market effects, while informal payments affect most vulnerable social groups and they are a barrier to social inclusion, as concluded at the conference. Speaking of informal payments, Ms. Lakićević asked why people give more money than it is needed. “Do informal payments constitute the practice of showing that patients are not aware of their rights, or such payment represent errors in the functioning of the health care system that is not able to provide health care services appropriately?“ she asked.

“We have a similar situation in many other countries,” said Mr. Rastislav Vrbensky, UN Resident Coordinator and UNDP Resident Representative to Montenegro. “With this event, we are building upon the productive partnership with the Ministry of Health and World Health Organization, initiated with the integrity assessment of the Montenegrin health care system. Let me use the opportunity to commend the efforts of our partners in the Ministry of Health for taking steps towards well-rounded, objective and thorough analysis of the Health Care System’s functioning in Montenegro, involving 4.500 respondents and focusing, for the first time, on the issue of informal payments. The assessment provided valuable data on the functioning of the health care system, i.e. evidence base for the continuation of health system reform processes. And since the assessment revealed high occurrence of informal payment (50%) and significant amounts being paid on top of formal contributions to the health insurance (8.5% of the gross average salary), actions need to be taken,” Mr. Vrbensky said, emphasizing that these data will help continue the reform process in this area.

“Let me mention that we take this opportunity to raise awareness on the detrimental effects of corruption. We are therefore taking part in the global anti-corruption campaign with financial support from the UNDP Democratic Governance Group. It should also be recalled that the United Nations Convention against Corruption, the only universally binding legal instrument against corruption, provides legal basis for action by state parties to fight corruption by means of prevention, criminalization, law enforcement and asset recovery. Montenegrin Government not only acceded to the Convention, but is also undergoing the process of reviewing implementation; such commitment of the Government should be commended. The Convention today boasts 140 signatories and 158 states parties, a massive worldwide coalition in response to a global threat,” Mr. Vrbensky concluded.

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There is now a consensus on the detrimental effects of corruption. Faced with the lingering effects of the global financial turmoil, both development and state resources become scarce.

“When desperately needed development funds are stolen by corrupt individuals and institutions, poor and vulnerable people are robbed of the education, health care and other essential services,” said UN Secretary-General Ban Ki-moon on International Anti-corruption Day.

It is often that we hear how corruption undermines democratic processes, hinders economic prosperity and growth, distorts public trust, and destroys the very foundations of the rule of law by perpetuating the culture of inequality and uncertainty as to how the regulations are applied. However, it is not so often that we ponder on the impact of corruption to the lives of our citizens: what is the cost of corruption?

Indeed, corruption contributes to social exclusion by means of depriving the poor and the disadvantaged of access to basic social services. Informal payments increase the cost of services in a manner which makes many of our citizens unable to take part in processes which make up a society: political, civil, electoral, etc. Even if we calculate the impact of corruption to an average household income, it is the trust in public institutions that will suffer an irreparable damage.

Steady, well thought-through response to the challenges posed by the scourge of corruption is called for, and the only way to be effective in resolving system deficiencies is to know the enemy. Assessing the extent, cost, dynamics and perceptions of corruption is a useful first step in any anticorruption strategy. It is such evidence-based planning that is more likely to produce the desired results. In addition, the more information we have on roots and causes of corruption, the more we can contribute to raising awareness and shaping public expectations in terms of supremacy of law, quality of life and equality in access to rights and services. And, as demonstrated by the recent events world-wide, it is the expectations of the citizenry that shape the future of the societies!