STRATEGIC DEVELOPMENT APPROACH OF PUBLIC HEALTH IN THE MUNICIPALITY OF KANJIŽA BETWEEN 2011-2020

There are several health care institutions in the municipality of Kanjiža: Health Centre of Kanjiža (1 medical station, 8 outpatients, 7 pharmacies), Special Hospital for Rehabilitation "Banja Kanjiža", and some private surgeries (10 private enterprises). These public health institutions have to fulfill the needs of 27,510 inhabitants in 13 settlements on an area of 400 km2. The Central Health Found annually participates with 300 million dinars in financing health care services in the municipality. More than 70 well-educated medical workers ensure adequate quality and professional level of services. The municipality is characteristic of fragmented settlement system and policentric structure (Kanjiža - Horgoš). Therefore public health system faces (material, human and quality) deficiencies in its sustainability. Health care institutions of the municipality collaborate with the surrounding secondary and tertiary institutions (hospitals). "Banja Kanjiža" is of strategic importance both from the aspect of health tourism and balneology, having traditionally good reputation. However its situtation is stagnant or even declining due to lack of investments.
The financial report of health care institutions for the year 2009 indicates high level of indebtedness and budget deficit. The Health Centre of Kanjiža is in the first place in the region concerning high depreciation rate of fixed assets (68.99%). The same is true for the medical bath. These problems could be resolved over founder's legal practice with adequate budgetary background from the local government. However, transfers of the local budget in the municipality of Kanjiža are below both the state and provincial average (2.35%).
Characteristics of socio-demographic and social medicine profile of the population are:
- Demographic ageing (the average age is 40-43-45, depending on villages), very high proportion of the population is older than 65, presence of vulnerable social groups (Romas (2.64% in two settlements: Horgoš and Adorjan), smaller number of refugees)).
- Health care system should pay special attention to the following population groups: children (4,896), adults (17,154), people above 65 (4,704), women above 15 (11,613), expectant mothers (144).
- The vitality statistics of the population are unfavourable in regional comparison (decreasing number of inhabitants (8,560 people less between 1971-2008), negative natural population growth (-7.8‰), low vitality index of the population (51.3), the life expectancy of men is the lowest in the region (67.69)).
- The most common diseases of adult population in Kanjiža are: diseases of the respiratory sytem (16.98%), diseases of the circulatory system (15.63%), diseases of the musculoskeletal system and connective tissue (10.85%), diseases of the genitourinary system (10.15%), and injury, poisoning and certain other consequences of external causes (7.86%).
- In 2008 the main causes of death in Kanjiža were diseases of the circulatory system in the first place (71%) followed by cancer or tumour (15%).
- Air and water pollution are in the first place among environmental damages.
- For developing health awareness of the population (hygiene, nutrition, physical activities, alcohol, smoking stc.) it is necessary to develop an action plan, in which preventive medical examinations play major role oriented towards vulnerable groups in partnership with local institutions (social, educational and civilian organisations).
Human resources are the main quality factors of health care. The maximum number of medical personnel in the municipality is regulated by a ministry decree. The minister backs it up every year with a plan of the number of medical personnel in health care. Some empirical researches performed in 2008 proved the fact that this region suffers from lack of professionals (specialists, skilled medical workers with high school degree), while unemployment rate is the highest among medical workers with secondary education. In regional comparison even Vojvodina and North Bačka are lagging behind the Serbian average concerning the number of specialists, pharmacists and dentists. The number of specialists is the lowest in Kanjiža: 0.81 physicians on 1,000 inhabitants (2.09 in Serbia, 1.63 in Vojvodina). For adequate human resources management it is necessary to provide active local planning, scholarship policy and participation of local government.
After summarising situation analyses and empirical researches follows the SWOT analysis, in the final phase of strategic planning. We can formulate some characteristics: Strenghts: renovated buildings, trust, experience, natural resources (thermal water, mud), Weaknesses: human resources, hardly motivated workforce working in rural environment, high territorial fragmentation, Opportunities: competitive and well found specialists services, dental health services, health tourism, Threats: reforms, negative demographic trends, unemployment, emigration. Then comes the formulation of vision and mission statement. Vision: Providing good quality and developed health care for every inhabitant of the municipality of Kanjiža. Mission: good technological preparedness (medical, information technology), international standards, well-educated medical personnel, nice and pleasant atmosphere (energy efficiency, environmental protection), providing health services utilising natural resources (thermal water, mud), with special attention to social health position, needs and health awareness of the inhabitants and developing partnership between institutions. Strategic goal: developing integrated health care in the municipality of Kanjiža. The strategic goal contributes to improved health conditions of the population, cost efficiency, utilisation of complementary sources (EU, Vojvodina stc.), consumer satisfaction. Five programs dedicated to the realisation of the strategic goal are: infrastructural development of health care (1), improving energy efficiency (2), primary health care and prevention, partnership for health (3), continuous development and further training of medical personnel (4), implementation of integrated information system (5).

Keywords: regional health care, medical personnel, human resource development, financing problems, strategic development opportunities, action plan