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Over 700 practitioners from 37 countries exchange views on the lessons learned from a decade of change.

pleanry The USAID-sponsored conference on Ten Years of Health Systems Transition in Central and Eastern Europe and Eurasia was held in Washington, D. C. at the Washington Hilton Hotel and Towers on July 28-31, 2002. The agenda incorporated the enormous cross-regional diversity of approaches to health systems transition in the CEE and Eurasia geographic area and balanced country and donor representation. Over 700 participants from 37 countries attended; and the 125 presentations sparked lively discussions and a rare opportunity to gain an overview of the vast changes that have occurred.

"Values in a health care system should not just be good intentions. They must be translated into action."

Dr. Marc Danzon, Director, WHO Regional Office for Europe, emphasized a critical issue that is often overlooked amid the complexity of technical redirection of a system. He further elaborated on this point. "Technical approaches to improving health care systems must place solidarity and universal access at their core. The poor and fragile must not be left out of the system." Click here to listen...

"Expensive and time-consuming mistakes have been avoided by developing partnerships and collaborative programs with other countries."

Dr. Radu Deac, Secretary of State, Romanian Ministry of Health, observed that the pieces of the health reform puzzle have been modeled in various countries and collaboration enables countries to teach and to learn from each other. Click here to listen ...

The Conference Coordinating Committee

To guide program development USAID organized a coordinating committee, which included representatives of the U.S. Department of Health and Human Services (DHHS), the World Bank, the World Health Organization (WHO-Euro), the European Observatory on Health Care Systems, USAID and the American International Health Alliance (AIHA). They were actively engaged with the objective of providing a unique learning experience that could be the foundation for future health transition efforts of country leaders and donors.

Nominations for presentations were submitted by the Aga Khan Foundation, Canadian International Development Agency, DHHS, the Open Society Institute, the Humana Foundation, TACIS, the U.K. Department for International Development, USAID,WHO and the World Bank. The depth of experience reflected in conference presentations was substantial.

"Are people better off after 10 years of transition?" asked a senior World Bank official in plenary address.

Chris Lovelace, Director of Health, Population and Nutrition noted that there are new models of primary care and increased consumer choice, but changes such as the adoption of social insurance have been "a double edged sword." He emphasized that reform is always "context-specific" because each country's macroeconomic, social and political environment determines the direction and progress of change. But there are three broad themes needing attention across the region as countries go forward. Click here to listen...

Media coverage of conference heightens visibility of health reform in the region.

To promote an active partnership between public health professionals and members of the mass media, USAID supported a group of 13 journalists who cover public health issues to attend the conference...

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"Reform is never over. .. continuous analysis is needed."

Yuri Shevchenko, Minister of Health of the Russian Federation, addressed the impact of transition on the functioning of the health care system, and the direct link between a nation's economy and its ability to provide good health care. Click here to listen ...


"Country borders are artificial barriers that don't relate to health at all. Our countries share many of the same public health risks."

Dr. Eve Slater, Assistant Secretary of Health, U.S. Department of Health and Human Services voiced strong support for cooperation and collaborative efforts with the CEE and NIS countries. She described 6 recently crafted principles to guide the vision for the next 10 years, adding a seventh -- communication. Our countries face common challenges such as tobacco use, diabetes, overweight and inactivity and HIV/AIDS/TB and we must share information, best practices and public health interventions. Click here to listen ...

Conference Evaluation and Impact

Conference participants typically complete evaluation forms to provide feedback on the quality of presentations, conference facilities, etc. Instead, participants are invited to provide comments, through the conference website, on the quality of the conference program and how you were able to apply what you learned after the conference ends. We will be sending you follow-up e-mail messages in three months and six months to invite you to share how you applied the new and improved ideas and approaches you took home from the conference.

Please send your comments to Mr. Forest Duncan, Health Development Officer, Bureau for Europe and Eurasia, U.S. Agency for International Development, by clicking here: [email protected]

"Senior policy makers and donors agree -- "The people need to be involved for changes to be sustained." This was the recurring sentiment during a lively dialogue on the pressing issues for the future."

Dr. Kenneth Shine, Director, RAND Center for Domestic and International Health Security, led an exchange on the most important future issues for success in health reform. Senior policy makers from 21 countries and donor representatives from USAID, The World Bank, WHO, DFID and the Open Society Institute participated in an interactive program which concluded the 3 day conference. Click here to listen...



This website offers an opportunity to expand your knowledge of the challenging realities of system transition and to continue to learn from each other. The names and contact information for conferees are provided so that you may follow up with questions, comments and on-going dialogue. In addition to sharing knowledge person-to-person, you can access over 150 presentations that were made at the conference.

All plenary speeches available through audio linkages, giving the opportunity to view the power point slide presentation (when available) as you listen. The conference theme papers and presentations on the papers are also posted as part of the proceedings of each track. Power point presentations and abstracts for all panel sessions provide an additional resource where the techniques for achieving successful change are revealed.


Five key areas of reform are framework for conference program

The conference program was organized around five key areas of health system transition. Six conference theme papers provided an overview of ten years of health sector reform in the region as well as in-depth analysis of trends in each key area. These papers provided the framework for discussing reforms. Each became a dedicated track of five panel sessions. They were

Track 1: Facing the Challenges of Health Care Financing

Track 2: Improving the Continuum of Care

Track 3: Improving the Quality of Health Services

Track 4: Mobilizing Citizens and Communities for Better Health

Track 5: Advancing Public Health

Transition leaders from many disciplines contributed to the program. These included policy makers and public sector leaders at the local, regional and national levels, clinicians, advocates, managers, journalists, academics and entrepreneurs, among others.

Topics of presentations and dialogue ranged from scholarly commentaries on trends, emerging issues and new directions to practical guidance on the challenging task of implementing durable improvements in system operations. Conferees agreed that capacity building must be a priority. Discussions concluded with a recognition that all the issues are interrelated and planning for change must recognize the complex nature of reform.

"For most countries, reforms in the health system remain a critical and unfinished agenda."

Building on this theme, Keynoter Dr. Anne Peterson, USAID Assistant Administrator, Bureau for Global Health, reviewed lessons learned in the past 10 years of USAID programs in the region and initiatives underway to strengthen health systems. Click here to listen ...

"Recipes for health sector reform ….. didn't recognize the complexity of the new environment."

Dr. Armin Fidler, manager of the health sector programs in the Europe and Central Asia Region, The World Bank, said the pace of change was not expected and the need to review best practices is an important task as part of this ten year retrospective. Click here to listen ...

Consensus builds over 3 days of talks: Nature and pace of reform is always context specific, but there is much to learn from each other to advance change.

The conference concluded with summary reports on the most prominent messages from the five tracks and an impressive session on future directions of health system transition with the 21 leaders of country delegations and donor organizations providing commentary. While common elements of past experience and future challenges transcended all sessions, speakers noted that each country faces a different situation based on its macroeconomic, social and political context. Nonetheless, it is important to learn techniques from the experience of other countries and not repeat their mistakes.

Click here for The Conference Program at a Glance.

Click here for presentations and abstracts from the Tracks and Panels

Click here for Track Summary reports

Click here for The Conference Program at a Glance.

Click here to listen to the Dialogue of Policy Makers and Donors

"There is no solution that is a magic bullet. Rather health reform is a global phenomenon with relationships between the issues."

Dr. Josep Figueras, Director, European Observatory on Health Care Systems, introduced the five conference themes and described how changes in one part of a health care system will be ineffective unless the interconnections to other parts of the system are recognized. Click here to listen ...

"The approaches our countries take in health services have major political, social and medical consequences."

Fred Schieck, Deputy Administrator of USAID, welcomed conferees and spoke to the importance of the health sector. Quoting President George W. Bush he said, "Healthy and educated citizens are the agents of development." Click here to listen...

Conference Theme Papers Are Now Available Online

The first paper in this series is an overview of health sector reform in the NIS and CEE over the last decade. The following five papers introduce the five key system change areas. The papers represent the views of the authors and are not meant to be definitive nor comprehensive surveys on these themes, but rather a conceptual framework for the conference participants...Read more

"It's easy to forget how far we've come in 10 years"…. "Fatalism is the greatest barrier to change."

Dr. Martin McKee,European Observatory on Health Care Systems and Professor at the London School of Hygiene and Tropical Medicine, reviewed the history of changes in health status and health care systems and the challenges posed by the transition to democracy. He said future strategies must harness the benefits of the transition while minimizing the failings. Click here to listen...

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Plenary audience

OpPlen panel

OpPlen Micka

OpPlen panel

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Conference exhibits

PM&D Panel

Obs Launch

panel attendees


OpRec Georgian delegates

OpPlen Lovelace

3A panel attendees

Cyber Cafe

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