2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
On May 19, the Crisis Response Team decided that certain health care institutions that were designated for COVID-19 hospitals would gradually return to their normal work process. In such institutions, all medical workers will be tested for coronavirus and will start working only after a negative result.
The new building of the Clinical Center in Nis will resume its regular work on Friday, May 22, while the Institute for Orthopaedic Diseases Banjica will function regularly from Monday, May 25. Another two hospitals will resume their usual work shortly after (Hospital in Pancevo and Institute for Pulmonology in Belgrade).
The largest temporary COVID-19 hospital in Belgrade Faire was closed on June 4. In total, 1,300 patients were hospitalized in this facility between March 29 and June 4, and 620 health workers were engaged in their care.
After many designated COVID-19 hospitals resumed their regular work, the COVID-19 Crisis Response Team of the Serbian Government decided on 23 June 2020 to designate one new hospital as COVID-19 hospital in Belgrade (Hospital Bezanijska Kosa), increasing the number of designated hospitals in Belgrade to 3. Also, the team decided to designate again the Institute for Pulmology in Nis as a COVID-19 hospital.
Following an increase in the number of cases that require hospitalization, the COVID-19 Crisis Response Team has been adding new hospitals in the COVID system:
June 26: 3 large hospitals in Belgrade (Dragisa Misovic, Zvezdara and Zemun) and 3 hospitals in other parts of Serbia (Cacak, Uzice and Kraljevo)
June 29: Hospital in Surdulica, Clinical Hospital Centre “Dr Dragisa Misovic” became completely COVID-19 hospital (the hospital will treat infected children from the entire Serbia, as well as the infected patients who need haemodialysis)
July 2: Clinical Hospital Centres Zemun and Zvezdara became completely COVID-19 hospitals
July 6: military tent COVID-19 hospital in Novi Pazar with 110 beds was opened and sports hall "Stark Arena” in Belgrade was adapted to become temporary COVID hospital with 500 hospital beds
July 7: hospitals in Mladenovac, Smederevo, Smederevska Palanka, Pozarevac and The Orthopedic and Surgical Hospital "Banjica" in Belgrade became COVID-19 hospitals and a hospital in Arandjelovac was put on stand-by. Two hospitals in Belgrade are designated for all non COVID-19 related conditions and one hospital outside of Belgrade (Pancevo) is designated to receive non COVID-19 patients from Belgrade.
July 9: a hospital in Sabac with 500 COVID-19 beds, a hospital in Cacak and new (fourth in total) COVID-19 hospital in Vranje.
July 14: Institute of Rheumatology in Belgrade, special hospital Cigota in Zlatibor District and the Internal Medicine Clinic in Kragujevac were added to COVID-19 system.
July 17: The temporary hospital in the Arena Sports Hall in Belgrade is being equipped with the necessary installations for the distribution of oxygen that will enable it to receive patients who need oxygen support in the coming period. A temporary COVID-19 hospital with capacity of 120 beds has been established in Sabac in a sport’s hall of a local secondary school.
July 18: A military hospital in Novi Sad has been included in the COVID-19 system, with a capacity of 30 beds.
July 19: A temporary hospital has been established in the premises of Kragujevac Fair. The hospital will have a capacity of 150-170 beds.
On July 14, the government started the construction of the new facility for treatment of COVID-19 patients within the Military Complex "Zemun ekonomija" near Belgrade. The government announced that the hospital will be completed in the shortest possible period (https://www.srbija.gov.rs/vest/478039/izgradnja-kovid-bolnice-na-batajnickom-drumu-u-najkracem-roku.php).
Following a sustained decline in the number of hospitalized patients, the Minister of Health announced on August 4 that the Ministry of Health is looking to return 3 hospitals in Belgrade to their normal functions soon. The return of other hospitals to their normal functioning will be slow, and hospitals will be returning to normal functioning gradually, department by department (https://www.srbija.gov.rs/vest/481387/u-kovid-bolnicama-dovoljno-slobodnih-mesta.php). On August 5, the makeshift military COVID-19 hospital in Novi Pazar has been closed, and on August 10, the temporary COVID-19 hospital in Special Hospital Cigota on Zlatibor discharged its last COVID-19 patients and resumed its regular work. On August 12, two more hospitals in Belgrade have been discontinued from the COVID system (Clinic for dermato-venerology and Institute for rheumatology). After disinfection, hospitals resumed their regular work as of August 17. Clinical-hospital center Zvezdra left the COVID-19 system on August 18, and the Orthopaedic Hospital Banjica in Belgrade will be able to receive the first orthopaedic patients by August 24. On August 25, the Minister of Health announced that another big hospital in Belgrade, the Clinical Hospital Center Zemun, will leave the COVID system as of August 26 and return to its regular work. The Minister of Health also announced that hospitals in other parts of Serbia will increase capacities for non-COVID patients.
Following the increase in the number of newly registered COVID-19 cases, the COVID-19 crisis response team announced on October 16, that the COVID-19 temporary hospital in sports hall Stark Arena will be put back into operation as of October 19. The team announced that the strategy will be the activation of temporary hospitals, as the government wants to preserve capacities in regular hospitals for non-COVID patients (https://www.srbija.gov.rs/vest/491971/od-danas-preporuka-za-nosenje-maski-i-na-otvorenom.php).
Following an increased number of new COVID-19 infections, the COVID-19 Crisis Response Team started to gradually return to the COVID-19 systems many hospitals that were already previously part of the system. As of 10 November, four big hospitals in Belgrade were again fully dedicated to the treatment of COVID-19 patients (Zemnu hospital, Zvezdara hospital, Dragisa Misovic, and Bezanijska Kosa hospital). As capacities of Belgrade hospitals were already filed as of November 9, patients are transported to hospitals in neighbouring cities: Smederevo, Pozarevac and Mladenovac.
The Ministry of Health announced that, in addition to already functioning COVID-19 infirmaries, a new, additional triage centre will be opened in Belgrade, to alleviate pressure on the triage centre in the infectious diseases clinic.
The Ministry of Defense has also stepped up its hospital capacity that is included in the COVID-19 treatment system. In addition to Military hospital Karaburma in Belgrade, as of 4 November, Military hospital in Novi Sad is treating again COVID-19 patients, and military health personnel is engaged in the treatment of patients in a temporary hospital in the sports hall Stark Arena in Belgrade.
By the end of November, the Ministry of Health continued to include additional hospitals into the COVID-19 system. In addition to many clinics at tertiary level within Clinical Centres in Belgrade, Novi Sad, Nis and Kragujevac, COVID-19 patients are treated in many general hospitals across the country. A number of spa centers and specialised hospitals in spa centres are used for the treatment of mild cases (Niska Banka, Vrnjacka Banja, Banja Koviljaca, Seleters spa). The total number of hospitalized patients reached 7,499 on 1 December.
The new COVID hospital in Batajnica (suburb of Belgrade) was officially established on 4 December and will start accepting COVID-19 patients as of 5 December. A corner stone for the Batajnica hospital was laid on 1 August and it was completed in only 4 months. The Batajnica COVID hospital has a total of 930 beds, of which 680 at semi-intensive and 250 at intensive care unit.
The Prime Minister said on 4 December that 80 million euros has been invested in new hospitals and equipment in Serbia.
A new COVID-19 hospital was opened on 20 December in Krusevac with 493 beds, of which 150 are in the intensive care unit. 600 doctors, nurses and other medical staff have been employed in the hospital, which will be under the authority of the Clinical Centre of Nis. The president of Serbia stated that the equipment for the hospital costed €9.5 million.
On 28 April, construction of a new COVID hospital in Novi Sad started. The capacity of this health institution will be approximately 600 beds, of which approximately 400 will be intended for patients in semi-intensive care and 220 beds for patients who need intensive care
In addition to 4 Clinics for Infectious Diseases, the Government has repurposed 3 Clinical Hospital Centres in Belgrade (“Dragisa Misovic”, “Zemun” and “Zvezdara”), the Clinic for Pulmonary Diseases of the Clinical Centre of Serbia, the Clinic for Surgery at the Clinical Centre of Nis, and the Clinic for Pulmonary Diseases at the Clinical Centre Novi Sad for the treatment of Covid-19 patients. In collaboration with the army, several fair and sports halls have been repurposed to be improvised temporary hospitals for patients who have mild forms of the disease. Additional facilities are already being refurbished to add capacity. A military hospital in Belgrade (https://www.srbija.gov.rs/vest/en/153362/construction-of-new-hospital-at-karaburma-starts.php) started to receive patients on 6 April and a new hospital at the same location for the treatment of patients with moderate and severe COVID-19 infection was opened on 23 April with an additional capacity of 60 beds. The hospital has been equipped with 106 oxygen tanks and 60 respirators. On 7 April, 90% of capacity was already full and work on its expansion continued. On April 11, the Government designated General Hospital in Pancevo as COVID-19 hospital, a temporary COVID-19 hospital has been established in Novi Pazar and it is announced that soon the General Hospital in Leskovac will become COVID-19 designated hospital. As of April 16, 11 hospitals were designated as COVID-19 hospitals and additional 9 temporary hospitals for mild cases have been established. In that way, the government expanded the capacity for treatment of COVID-19 outside of four large urban centres. In total 3, 511 COVID-19 patients were hospitalised on 16 April.
On 24 March, the Government decided to include capacities of the large private medical provider MediGroup and 4 private hotels in Belgrade, Novi Sad and Nis to expand capacities for the treatment of COVID-19 patients (https://www.srbija.gov.rs/prikaz/454260).
A significant number of mechanical ventilators have been provided from abroad (mainly from China), together with a considerable amount of PPE and lab testing kits. Needs are being addressed both by governmental procurement and by donations. Minister of European Integration Jadranka Joksimovic stated on 7 April that Serbia has so far purchased 75 medical ventilators from the funds approved by the EU, which have still not been delivered, but are bought and paid. President Vucic announced on 5 April that 201 more mobile ventilators have arrived with additional 36 to arrive later that day. Currently, the representatives of UN agencies and development partners are trying to provide additional supplies. A large number of beds and all needed hospital equipment is provided by the army. The Government is also acquiring hotel capacities to accommodate health workers who are engaged in the COVID-19 care (https://www.srbija.gov.rs/vest/en/153437/directorate-for-confiscated-property-management-gives-four-hotels-to-government.php).