Transforming Care: How the AQH Project is Revolutionizing Primary Healthcare in Kosovo
1. Introduction: Setting the Stage
Kosovo has made significant strides in recent years, particularly in primary healthcare (PHC). The Swiss Agency for Development and Cooperation (SDC) through AQH Project and in collaboration with Ministry of Health (MoH) has played a pivotal role in this journey. While challenges such as managing non-communicable diseases (NCDs) remain, substantial efforts have been made to address these issues through reforms and capacity building.
In response to these challenges and opportunities, the Accessible Quality Healthcare (AQH) project has made significant results in enhancing the quality of PHC in Kosovo by introducing innovative practices, providing comprehensive training for healthcare providers and managers, and establishing Health Education Rooms across the country. These efforts were designed not only to improve the quality of care but also to make healthcare services more accessible and patient-centered.
Over the past eight years, the AQH project has had a transformative impact on Kosovo’s PHC system. It has empowered healthcare providers, particularly nurses and managerial staff, to take on more significant roles in patient care and health system management. It has also brought healthcare closer to the people, ensuring that even those in rural or underserved areas have access to the care they need. The following content and data explores the key interventions and innovations introduced by the AQH project, highlighting its impact on both healthcare providers and patients.
2. Key Interventions and Innovations
Health Education Rooms: A New Approach to Patient Care
One of the most notable innovations introduced by the AQH project is the establishment of Health Resource Centers or widely known as Health Education Rooms in primary healthcare centers across Kosovo. These rooms serve as dedicated spaces where patients can receive not only medical care but also critical health education and emotional support. The focus on education is particularly important for patients with chronic diseases, as managing these conditions often requires significant lifestyle changes and a deep understanding of the disease itself.
In these rooms, patients are provided with information about their conditions, including advice on diet, exercise, and medication management. For example, patients with diabetes receive guidance on monitoring their blood sugar levels and maintaining a healthy diet, while those with hypertension learn about the importance of reducing salt intake and increasing physical activity. The goal is to empower patients to take control of their health, leading to better outcomes and a higher quality of life. The reach of these services has significantly multiplied, starting from 4,000 visits in 8 municipalities in 2020, to now counting over 50,000 visits in 20 municipalities.
The Health Educ ation Rooms also offer a supportive environment where patients can discuss their concerns and receive emotional and psychological support. This aspect of care is often overlooked in traditional medical settings, where the focus is primarily on physical health. However, the AQH project recognizes that emotional well-being is just as important as physical health, particularly for patients dealing with chronic conditions.
Training Medical and Managerial Staff: Empowering Healthcare Providers
A cornerstone of the AQH project has been the extensive training provided to health managers, nurses, and other healthcare professionals. Before the project, many healthcare providers in Kosovo were not adequately trained to handle the complexities of chronic disease management or to provide the kind of patient-centered care that the AQH project promotes. The training provided by the AQH project has filled this gap, equipping healthcare providers with the skills and knowledge they need to deliver high-quality care.
Nurses, like Drita Jetullahu from Vushtrri, have benefited immensely from this training. Drita works in one of the Health Education Rooms and has seen firsthand how the training has improved her ability to care for patients. She now has the skills to provide detailed explanations of medical conditions and to offer practical advice on managing them. This has made a significant difference in the lives of her patients, many of whom now feel more confident and empowered to manage their health.
Additionally, the AQH project has focused on training managerial staff in health management and quality management. This training has empowered health directors and managers to implement best practices in their facilities, ensuring that the improvements in patient care are sustainable and aligned with national health policies. By strengthening the management capacities within PHC centers, the AQH project has contributed to more effective and efficient healthcare delivery across Kosovo.
3. Case Studies: Real-Life Impact
Vushtrri’s Transformation: A Community-Centered Approach
Vushtrri, a municipality in northern Kosovo, is one of the areas where the AQH project has had a profound impact. Before the project, the primary healthcare system in Vushtrri was typical of many municipalities in Kosovo—under-resourced and overstretched. Patients often had to wait long hours to see a doctor, and when they did, consultations were brief and lacked the depth needed to address chronic conditions adequately.
With the introduction of the AQH project, Vushtrri’s healthcare system began to change. The establishment of a Health Education Room in the Family Medicine Center was a key part of this transformation. This room provided a space where patients with chronic diseases, such as diabetes and hypertension, could receive regular check-ups and health education. It also became a place where patients could receive emotional support, something that had been sorely lacking in the past.
One patient who has greatly benefited from the Health Education Room in Vushtrri is Resmije Ibrahimi. Five years ago, Resmije weighed 104 kilos and was struggling with her health. She found the healthcare system difficult to navigate, and her consultations with doctors were often rushed and unhelpful. Vushtrri’s evaluation of patient-clinical relations was 20% lower in 2016 compared to now. However, since the establishment of the Health Education Room, Resmije’s experience has changed dramatically. She now weighs 91 kilos and credits the guidance and support she received from the nurses for her improved health. «I feel like I’m with family here,» she says, describing the supportive atmosphere in the Health Education Room.
The impact of the AQH project in Vushtrri extends beyond individual patients. The project has also changed the way healthcare providers approach their work. Nurses like Drita Jetullahu, who works in the Vushtrri Health Education Room, now have the time and resources to provide comprehensive care. This includes not only monitoring patients’ physical health but also offering advice on diet, exercise, and stress management. The result is a more holistic approach to healthcare, one that takes into account the physical, emotional, and psychological needs of patients.
Lipjan: A Model Municipality
Lipjan, a municipality in central Kosovo with about 60,000 residents, has emerged as a model for other regions thanks to its successful implementation of the AQH project. The local health system’s commitment to collaboration and improvement, combined with infrastructure investments, has made Lipjan a standout example of what can be achieved when the AQH project’s principles are fully embraced.
Since 2016, Lipjan has been actively involved with the AQH project, focusing on integrated care services for people with non-communicable chronic diseases. The municipality has made significant investments in infrastructure, including the development of walking paths, cycling lanes, and green spaces. These investments have not only improved the physical environment but have also encouraged residents to adopt healthier lifestyles. In fact, since 2016, Lipjan has seen an improvement in infrastructural capacities of over 35%, one of the highest achievements for AQH’s partner municipalities.
The success of Lipjan’s implementation of the AQH project can be attributed to several factors. One of the most important is the empowerment of nurses. Shkëlzen Hajdini, the health director of Lipjan, has emphasized that good primary care is impossible without empowering nurses and providing quality services. The training provided by the AQH project has enabled nurses to take on more significant roles in patient care, allowing them to offer more comprehensive and personalized services.
Additionally, Lipjan has focused on training its managerial staff in health management and quality management. This has ensured that the improvements made in patient care are supported by strong leadership and effective management practices, contributing to the sustainability of the project’s impact.
Another key factor in Lipjan’s success is the municipality’s commitment to community engagement. The local government has organized awareness caravans and information campaigns to raise residents’ awareness about their general health. These initiatives have been organized through AQH project only, but now they are initiated by the will and budget of municipality too. They helped to build a strong sense of community and have encouraged residents to take an active role in managing their health. Part of this initiative included establishing patient councils, which have empowered citizens to voice their concerns and seek their rights as patients, further enhancing the quality of care.
Lipjan’s achievements have not gone unnoticed. Other municipalities in Kosovo have taken note of Lipjan’s success and have sought to learn from its experience. As a result, Lipjan has become a model for other regions, demonstrating the potential of the AQH project to transform primary healthcare across the country.
Growing Interest from Other Municipalities
The success of the AQH project in municipalities like Vushtrri and Lipjan has sparked interest from other regions in Kosovo. The municipality of Vitia, located in eastern Kosovo, is one such example. Inspired by the positive results seen in other areas, Vitia has expressed a strong desire to collaborate with the AQH project to train nurses and provide educational counseling.
Vjollca Kadolli, the director of the Main Family Medicine Center in Vitia, explained that witnessing the close relationships between citizens and nurses in other municipalities motivated her to seek similar changes in Vitia. In 2014, Kadolli had opened a health education room for diabetes and hypertension, but it was forced to close due to financial instability. Now, with the support of the AQH project, Kadolli is hopeful that Vitia can replicate the success seen in other municipalities, particularly in providing emotional and psychological support to chronic patients.
Kadolli believes that training nurses and managerial staff will change their behavior towards patients, who are often emotionally burdened and have various problems they may not even discuss with their families. «Chronic patients need a lot of emotional and psychological support,» she concluded, highlighting the importance of the comprehensive care approach promoted by the AQH project.
4. The Role of Nurses and Managers: Empowering Healthcare Providers
Nurses as Frontline Heroes
Nurses have always been at the forefront of healthcare, but the AQH project has empowered them and elevated their role even further. Through extensive training and the establishment of Health Education Rooms, nurses have become important figures in the delivery of primary healthcare in Kosovo.
The training provided by the AQH project has equipped nurses with the skills and knowledge needed to manage chronic diseases effectively. They have learned to communicate diagnoses in a way that minimizes patient anxiety, provide detailed guidance on managing health conditions, and offer emotional support that is often as vital as the medical care itself.
Nurse Drita Jetullahu’s experience in the Vushtrri Health Education Room illustrates the impact of this training. She describes how her approach to patient care has changed, with a greater emphasis on spending time with each patient, understanding their needs, and providing comprehensive care that goes beyond just addressing physical symptoms.
Emotional and Psychological Support
The AQH project recognizes that managing chronic diseases requires more than just medical treatment. Patients often need emotional and psychological support to cope with the challenges of living with a chronic condition. The Health Education Rooms have become places where patients can receive this support, helping them to feel more in control of their health and less isolated in their struggles.
Nurse Burbuqe Gjoni, who works in one of these rooms, emphasized that the main goal of the medical staff is to educate patients about their diseases and teach them how to manage them. This education is not just about conveying information; it’s about building relationships with patients, understanding their fears and concerns, and providing reassurance and support.
Training and Empowering Managers
In addition to empowering nurses, the AQH project has placed a strong emphasis on training and empowering managerial staff within the healthcare system. Until 2023, AQH trained 407 personnel, who comprise the majority of management staff in national PHC centers. This training in health management and quality management has been crucial in ensuring that the improvements made at the patient level are supported by effective leadership and sustainable management practices.
By equipping health managers with the tools and knowledge they need, the AQH project has helped to create a more resilient and adaptable healthcare system in Kosovo. This has not only improved the day-to-day operations of healthcare facilities but has also ensured that the positive changes introduced by the project can be maintained in the long term.
5. Challenges and Lessons Learned
Initial Barriers
The implementation of the AQH project was not without its challenges. One of the primary barriers was the initial resistance to change. Healthcare providers, particularly those who had been working in the system for many years, were often skeptical of new practices and reluctant to adopt new methods of patient care.
Financial constraints also posed a significant challenge. Establishing Health Education Rooms and providing extensive training required substantial investment, which was not always readily available. However, the commitment of the SDC and the determination of local health authorities helped to overcome these obstacles.
Overcoming Obstacles
The success of the AQH project in overcoming these challenges can be attributed to several factors. Continuous training and support for healthcare providers helped to ease the transition to new practices. The project also emphasized the importance of community engagement, ensuring that patients and healthcare providers alike understood the benefits of the changes being introduced. Through local community sessions, over 24,000 people interacted with health services and information outside of health institutions.
Collaboration with local health authorities was another key factor in overcoming challenges. By working closely with municipal health directors and other local leaders, the AQH project was able to tailor its interventions to meet the specific needs of each community, increasing the likelihood of success.
6. Sustainability and Future Prospects
Ensuring Sustainability
As the AQH project moves forward, ensuring the sustainability of its achievements is a top priority. The project has implemented several measures to ensure that the gains made in Kosovo’s primary healthcare system are maintained in the long term.
One key aspect of sustainability is the ongoing training and professional development of healthcare providers. The AQH project has established a framework for continuous education, ensuring that nurses and other healthcare professionals can keep their skills up to date. This will allow them to continue providing high-quality care, even as new challenges and diseases emerge.
Another important factor is the integration of the AQH project’s practices into Kosovo’s national health policies. By working closely with the Ministry of Health and other national institutions, the AQH project has ensured that its innovations are not seen as temporary solutions but as integral parts of the country’s healthcare system. For example, two key strategic documents related to Health Education and Promotion and NCD management, include many AQH initiated activities.
The project has also made significant strides in training managerial staff in health management and quality management, which is crucial for the long-term sustainability of the improvements made. By strengthening the leadership within healthcare facilities, the AQH project has laid a solid foundation for continued progress and adaptation in the face of future healthcare challenges.
Future Directions
Looking ahead, the AQH project has several key areas of focus for the future. One priority is the expansion of Health Education Rooms to more municipalities, ensuring that all citizens in Kosovo have access to these vital services. Another focus is on further enhancing the training provided to healthcare professionals, with an emphasis on new and emerging healthcare challenges.
The project also aims to build on its successes by fostering greater collaboration between municipalities. By sharing best practices and lessons learned, municipalities can continue to improve and innovate, leading to even better outcomes for patients across Kosovo.
7. Conclusion: A New Era for Kosovo’s Healthcare
The AQH project has brought about a transformative change in Kosovo’s primary healthcare system, making it more accessible, efficient, and patient-centered. Through the establishment of Health Education Rooms, the training of healthcare providers, and a focus on patient-centered care, the project has improved the quality of life for countless Kosovars, particularly those with chronic diseases.
As Kosovo continues to build on these successes, the lessons learned from the AQH project will serve as a valuable guide for future healthcare initiatives. With continued support and collaboration, Kosovo’s primary healthcare system can continue to grow and thrive, providing high-quality care for all its citizens.
Note: this article is jointly developed with Prishtina Insight Magazine.
