Croatia Health Profile 2012

HEALTH & DEVELOPMENT
Mortality and morbidity in Croatia - In total population, the leading causes of death in 2008 were circulatory diseases(591.2/100,000), followed by neoplasm, responsible (299.3/100,000). These two disease groups accounted for three quarters of overall causes of mortality. On the scale of ten leading individual causes of death in 2008 in Croatia, five belong to the cardiovascular group of diseases. The three leading diagnoses are ischemic heart disease, followed by the cerebrovascular diseases and heart failure while the ninth and tenth areatherosclerosis and hypertension. The remaining deaths were caused by injuries and poisonings (68.4/100,000), diseases of the digestive system (54.8/100,000), diseases of the respiratory system (50.7/100,000) and other less common causes. In 2008, Croatia recorded 3,034 violent deaths. Among accidents with a rate of 48.4/100,000, the leading were deaths due to falls with a rate of 19/100,000. Suicides had a rate of 17.9/100,000.
Non communicable diseases and life style risk factors - In Croatia there is a higher percentage of smoking males than females, and a greater percentage of overweight /obese males. It also shows more males engaging in sport, but a higher percentage of active working females doing lighter work, with only a small percentage of them doing markedly heavy work. Data on dietary habits indicate lower consumption of fruits and vegetables among men in comparison to women, while fat, salt, meat and alcohol consumption are on the overall greater in male population. Thus, the cardiovascular disease group imposed itself as a health system priority. Cardiovascular diseases are also the leading cause of hospital treatment of Croatia’s inhabitants, and in the second place of diagnoses registered in primary health care. Mental disorders as a group are among the leading causes of hospitalization in 2008, with two thirds of all such cases involving alcoholism, schizophrenia, depressive disordersand reactions to severe stress, including Post-traumatic Stress Disorder (PTSD).In order to strengthen NCD prevention programmes, country endorsed the NAP for prevention of CVD, the NAP for prevention of obesity and the National program for health protection of persons living with diabetes. National Cardiovascular Disease Prevention Programme, endorsed in 2001, includes not only primary and secondary prevention but also health promotion with the purpose of entirely precluding the occurrence of health hazards aiming at: lowering the
coronary and myocardial infarction mortality to the age of 64 years by 20%, improving the detection and treatment of hypertension, improving the detection and treatment of hyperlipidaemia, reducing the number of smokers, especially among young, by 10%, reducing the number of obese by 20%, promoting healthy nutrition and increasing the number of inhabitants engaging in regular physical activity. Other national preventive health programs are related to implementation of preventive check-ups for persons older than 50 years (CVD, HBP, diabetes, anemia); screening program for early detection of breast cancer and colorectal cancer; national programme for intervention cardiology.

Control of communicable diseases - Croatia has a mandatory vaccination program, which is improved every year on the basis of best practice evidence. High vaccination coverage rates are recorded. Surveillance and early response system is in place for many years, thus keeping most communicable diseases under control. TB incidence in 2008 is 22,9 o/oooo. In Croatia prevalence of veneral diseases exhibit a favourable low incidence. According to EuroHIV, Croatia has a low-level HIV epidemic with rate of <10 newly diagnosed cases of HIV infection per million population per year. In the last ten years an average incidence is about 15 (<4 newly diagnosed cases of HIV infection per million population). Risks of HIV outbreaks are estimated as moderate,partly the result of many years of primary and secondary prevention efforts. Between 1985 and 2009 there were 792 documented cases of HIV infection, 301 of which progressed to AIDS. During the same period of time, of the 792 diagnosed HIV 164 patients died. Four fifths of HIV/AIDS cases are male, who are mostly infected between the age of 25 – 49 . Most of the infected patients have acquired the infection abroad. HAART is offered  to all patients who require it and all persons who need are receiving antiretroviral drugs (ARVs) at the costs which is fully covered by the public health system.

Stewardship role of MoH - In 2006 the Government adopted the National Health Strategy 2006-2011 document. Among other, the Strategy is tackling health system accessibility, fairness and equity, health system efficiency, safety of patients and health workers, improvement of quality of service delivery. The Ministry of Health supports the principle of integrated care, providing acute and chronic health care in local community through significant strengthening of the primary health care with the aim to establish efficient control over the use of secondary and tertiary capacities and general health care system expenditure, aiming at solving of up to 80% medical cases in the primary health care. MoH is supporting the full computerization of health system and introduction of telemedicine for geographically remote areas such as islands.

OPPORTUNITIES

• Integration with the EU
• Potential financial assistance to health sector from the EU funds.

CHALLENGES

• Decentralization of management and responsibilities
• Relatively slow implementation of health sector reforms and challenge to reduce bureaucratic measures