A DOCTOR FOR EVERY FAMILY

Within the framework of the implementation of the health services reforms project (HSRP), which is financed by the World Bank Group (WBG), the Azerbaijani Health Ministry has taken steps towards the development of a national family-based system of medicine (Fineko/abc.az).  The ministry has already attracted extra resources in addition to those envisaged by the project to create a legal framework for this area of work, in particular, resources from the US Agency for International Development (USAID).  However, this does not yet mean that the law 'On Family Doctors' will be adopted in the country in the near future:  there are no such plans yet.  For now, the Health Ministry's order is enough.  Issues of legal regulation have been postponed to the distant future, until the system of family doctors is established.  At present, the ministry has only officially introduced a new medical speciality, the family doctor, redesigned the tables of organization and established standard salaries for family doctors, which were determined using the standards for general practitioners.  To train them for the pilot regions in the project, 10 specialists have already been selected and completed accelerated training courses at Haci Tepe University in Turkey, and they will be retraining family doctors locally.

Monitoring, detection and prevention...

Despite the presence in the country of about 300 specialists who have undergone retraining courses, they cannot work as family doctors yet.  Simultaneously, the Health Ministry is preparing documents to regulate the work of family doctors and a system of certification, accreditation and licensing is in development.  The family doctors will monitor, detect and prevent the spread of diseases at primary (lower) level to prevent the diseases from reaching tertiary (hospital) level.

"In the past, the outpatient polyclinic service had a system whereby the area serviced by the medical institution was divided into areas serviced by two district doctors - for adults and for children.  When necessary, specialists were involved, for example, ophthalmologists or laryngologists.  Furthermore, the district general practitioner was in charge of internal medicine, and when other doctor's help was needed, the patient was referred to the specialist.  Today, there is nothing like a 'district doctor' in many other countries.  In the West, the family-based system of medicine was adopted.  In essence, the family doctor is a specialist who, besides an intern's skills, can perform basic ophthalmological, laryngological and gynaecological tests.  And he examines not only adults, but also children," says the Health Ministry press service.  However, the department is certain that the innovation will have to be introduced stage by stage, given the number of district doctors in the country and the lengthy period during which the old system was in operation.  At present, different pilot projects are under way, and this means that no one has abolished the district doctor system yet.

Specialists maintain that the family-based system of medicine has proved quite effective, if only because there is no need to waste time in busy schedules visiting different specialists.  The "family doctor" qualification entitles the doctor to provide consultations to all family members in all areas of medicine, involving specialists for consultations and coordination of treatment only in exceptional cases.  He has the medical records of all family members from the moment of birth, which helps him considerably.  The family doctor may advocate healthy life styles and advise families on diets and family planning.  The doctor observes the family members over a long period and can take account not only of the outward signs of a condition or symptoms of a disease.  Physical, psychological and social factors help him to choose the optimum treatment for the disease in 80 cases out of 100.  For example, if symptoms of a disease are apparent, a patient without a family doctor has to go to specialists and becomes a "prisoner" in a "medical labyrinth."  When the doctor cannot find a problem in the organ which seems to be causing concern, the doctor sends the patient for dozens of consultations and examinations by other specialists.  However, disease is much easier to prevent than to treat.  The family doctor periodically conducts preventive examinations and helps prevent serious illnesses like cancer, myocardial infarctions or strokes.  In some cases, genetic testing is conducted, which helps "predict" the possibility of the development of a number of diseases by the patient or by his or her progeny.  In difficult cases which require specialized aid, the family doctor organizes councils with the participation of the best specialists and consultants in that particular speciality.  This is how the system works in the West and, if it is introduced in Azerbaijan, this will be a major step forward in the development of the health care system.

...And other reforms

Overall, the project of Azerbaijani health sector reform, with $50 million to be invested, is the largest investment in the country's social sector.  The full cost of the project is $86.75 million.  83% of the budget will be spent directly on the development of medical and social services, 14% on management at the level of central administration, and 3% on the management of mandatory medical payments.  The project has five main components:  strengthening the management potential of the Health Ministry; the creation of a policy, planning and regulation department there; improving the quality of medical services and their accessibility and effectiveness in the five pilot districts, which includes the creation of a primary medical aid level and building three district hospitals; the strengthening of ties between the primary and secondary levels of health care.  In addition, reforms will be conducted in the field of health care expenditure by concentrating funds in a single funding source.  It is planned that a transition to a per-capita principle of funding of the primary health care system and payment for medical services after provision will take place.  And of course, the potential of personnel will be developed by improving undergraduate training and by postgraduate retraining of medical specialists.  The Health Ministry stresses that from the day the agreement with the World Bank is signed, the latter will constantly monitor the implementation of objectives.  This is why the introduction of "family medicine" practice into the Azerbaijani health care system is not just a drop in the ocean which we will notice in the near future.