In 1991, the People-to-People Health Foundation (also known as Project Hope) worked with hospitals and Slovak NGOs to set priorities for and guide the distribution of urgently needed medical supplies and equipment. The U.S. Department of Health and Human Services (HHS) provided advice and training in policies and implementation strategies to the health insurance agency established in 1990. In 1994, after that system had been drained to support general government expenditures, HHS worked with the Ministry of Health to develop strategies to stabilize health care financing and design long-term reforms to promote efficient, high-quality health care. That effort did not bear immediate fruit, as the health insurance system was used corruptly to favor political allies, but in 2000 the government is using the knowledge and approaches learned from earlier technical assistance exercises to redesign the health insurance system.

Project Hope also supported a partnership between Boston’s Children’s Hospital and the Bratislava Children’s Hospital that carried out a highly successful program of improving biomedical engineering, health care management, nursing practices, neonatology services, cancer screening for women and the resuscitation skills of health care personnel. The University Children’s Hospital and the Slovak Pediatric Cardiovascular Institute, who also participated, instituted high quality pediatric cardiology/cardiac surgery and modern hospital management systems.

The regional Trnava Hospital and Polyclinic, with support from Healthcare Enterprise International and the Franklin Delano Roosevelt Hospital, raised the quality of its operations. That effort successfully transferred strategic planning concepts, implemented cost allocation and other financial planning improvements, and instituted new health care management techniques (quality improvement teams and the case manager concept). The project showed what could be done in a climate of financial stringency. Reforms of the health insurance system will be necessary to permit widespread adoption of all of the techniques showcased in this project.

The American International Health Alliance (AIHA) implemented three kinds of health programs to transfer skills between U.S. and Slovak health institutions. The health care partnership between the Kosice Faculty Hospital of Safarik University and Providence, Rhode Island Women’s and Infants’ Hospital improved maternal and child health in eastern Slovakia, in particular perinatal, neonatal, pediatric and gynecological medicine. Numerous clinical and operational procedures were changed and new regional referral and nursing educational services initiated. These resulted in higher overall occupancy rates, a doubling of admissions to the neonatal intensive care unit (including referrals from the five outlying hospitals also benefiting from the program), and significant drops in neonatal mortality rates at the hospital and in the Kosice region.

The second AIHA partnership program developed the health management education capacities of the Trnava University School of Nursing and Social Care, the Health Management School in Bratislava, and the Faculty of Economics at the University of Matej Bel in Banska Bystrica. Operating in partnership with the University of Scranton Department of Health Administration, it also established accreditation standards. As a result, all three institutions added health management courses and made other curriculum changes. A Masters program for Nurse Managers was established at Trnava University and accredited in 1998, as were Health Management programs. The University also established a Nursing Resource Center, a Center for Rehabilitation Medicine and a Health Management Institute. Matej Bel’s Health Management program was strengthened, and its Center for Health Strategy and Policy is a strong center of analytical expertise. A Center for Training and Consulting Skills Development was added at Bratislava’s Health Management School. Together, these resources will continue to provide all of Slovakia’s health management training needs well into the future.

Local health reforms were undertaken through three Healthy Community partnerships, under which partners identified health risks in the community and designed interventions to address them. Exchanges helped the partners determine which aspects of U.S. programs could best address the needs of Slovak cities. Local stakeholders mobilized volunteer support for health improvement activities. In the process, communities were empowered to develop health programs and gain experience in effecting change. The first two partnerships involved the Cleveland MetroHealth System, supported by several other Cleveland organizations, with the cities of Banska Bystrica and Martin. As a result of its program, Martin opened a Healthy City office, whose first effort was the design and implementation of a vigorous anti-smoking campaign. In Banska Bystrica, a new city department for health care was established, the regional hospital designated a 20-bed ward as a geriatric care unit, and a municipal 18-bed unit was established for pensioner care. The city also began a program that encouraged self-management of chronic disease that included the initiation of the area’s first ambulance service, a family stress reduction program and a city clean-up campaign. The third partnership, between Petrzalka’s Association of Aid to Children at Risk and the Truman Medical Center in Kansas City, is helping prevent drug abuse among teenagers and domestic violence. It designed and implemented an extensive drug awareness campaign for teenagers and trained teachers to recognize signs of drug or child abuse. It has also opened a crisis hotline and the Hope Center for battered women to provide counseling and self-help activities for women and children fleeing domestic violence or confronted with drug abuse crises.

Our health projects have made a significant difference in local and regional health care and training, to the benefit of many patients. They were undertaken as the best available alternatives to systematic reform, which was not of interest to the government at the time. Unfortunately, the projects do not add up to a systematic reform of health care and will not substitute for more basic needed improvements, especially in health care finance.