Quality of nursing care, availability and accessibility of treatment and prevention of communicable and chronic diseases.

Primary care

Provision of primary care based on district approach (in residential areas)

Networks of district outpatient clinics specifically working for adults and for children

Network of primary specialized outpatient clinics (women consultancy, cardiology)

Medical stations in rural territories with different staffing depending on population numbers – (doctor and nurse working jointly, or feldshers working alone/independent practice)

Medical rooms at schools and other education settings, large companies

Home visits, home care

Hospital care

Planned and emergency hospitalization

Multi-profile medical centers and specialized hospitals (cardiology, TB, mental health, transplantation, ets …)

Central district hospitals, delivery homes (to provide standard and most needed types of care and high technology centers to provide advanced treatment for patients with complicated health problems)

Trauma centers of different levels

Hospices and nursing homes

The number of therapeutic beds per 10 thousand population is shown in Fig. 1.

Fig. 1

The number of therapeutic beds per 10 thousand population.

Strengths

Extended network of outpatient clinics and medical stations covering all the territory.

Advanced immunization program

Health insurance covered by the state

Depending on the health status a patient may ask for a home visit, personally come to outpatient setting or get hospitalized if there is a need in emergency care.

Specific system of control for patients with chronic conditions based in primary care facilities (outpatient clinics)

State support of rural healthcare settings

Multilevel system of primary health care

Weaknesses

Lack of legislation for autonomous nursing practice

Medical profession dominates and gives low space for nurses to practice autonomously.

Health assessment, pregnancy care, chronic care, - in all these fields doctors play a major role and nurses an assistant role.

Traditionally low and dependent nursing role

Low efficiency of screening programs

Insufficient number of evidence-based practice guidelines for doctors and complete lack of guidelines for nurses working in primary care

Opportunities

Approval of professional standards with extended nursing roles

Redistribution of tasks between nurses and GP doctors, change of nurse to doctors ratios

Collection and dissemination of best practices

Development of clinical recommendations based on evidence

Change of the model of nursing practice in primary care

Threats

Lack of legislative changes based on new concept of nursing will not allow to perform all planned activities

Commercialization of healthcare that can lead to decreased availability of care and even more decreased role of nurses

RNA strategy – a way forward

To continue support of professional standards that can increase the nurses role in hospital and primary care and support an independent scope of nursing practice

To participate in global and regional work groups influencing policy and practice

To provide nurses with knowledge and information on potential growing role and status of nursing profession

To participate in public debates on healthcare provision and focusing attention on nursing power that can allow more care of a better quality and availably at a lower cost