3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
Slovakia adopted on 11th of December a gradual COVID-19 vaccination strategy. The aim is to vaccinate 65 % of the population aged over 18. The vaccination will be carried out in four waves.
The first wave comprises following groups, that are deemed crucial for various tasks, such as: Healthcare workers; field social workers, staff of organizations involved in the treatment of patients with COVID-19; employees of the critical infrastructure of the state; employees of the state e.g. military, or police that are in possible direct contact with the at-risk population
The second wave comprises those patients aged over 65; and gives priority to patients in care homes and suffering from chronic diseases (e.g. cancer, cardiovascular diseases, psychiatric diseases, diabetes, autoimmune diseases) and patients deemed of high risk for infection (e.g.dialysis patients, transplanted patients; patients with impaired immunity; on biological treatment). Additionally, immobile patients are eligible for vaccinations provided by mobile units.
The third wave comprises teachers, marginalised communities, homeless people and asylum seekers. While, the fourth and final wave aims at other inhabitants over 18 years of age.
On January 20, new criteria determining the order of vaccination came into force. Accordingly, the vaccination is divided into 11 phases. The individual phases begin with the opening of the login in the central ordering system. If all those booked through the central ordering system are not vaccinated on a given day, unused doses of the vaccine may be given priority to hospitalised people over the age of 65, or to people with chronic or significantly ill diseases increase the risk of a more severe course of COVID-19. The reason for these changes was a result of expert request to optimise vaccination efforts to reduce mortality in the first turn.
In the first phase, the following groups can be vaccinated:
• medical and non-medical students who come into contact with patients during their studies,
• employees of social services facilities,
• field social workers,
• the staff of the service organization who carry out their activities in the hospital,
• employees of the hospital, emergency medical service and transport medical service who meet the patient,
• persons who provide spiritual service within a church or religious society for patients with COVID-19 in a hospital or for recipients of social services in social services facilities,
• employees of the mobile sampling point who meet the test persons.
In larger groups, vaccination is organized in the first phase for:
• recipients of residential social services in social services facilities, vaccinated directly in these facilities,
• patients who regularly need haemodialysis with a healthcare provider who is licensed to operate a hospital in the field of nephrology - but vaccination should be provided by the healthcare provider,
• patients currently undergoing outpatient chemotherapy - vaccination should be provided by a health care provider receiving chemotherapy,
• immobile lying patients with a serious illness, vaccination should be provided by an outpatient care provider.
In the second, third and fourth phase, mainly age is the determining factor (first people aged 85, then 75 and finally 65 years).
In the fifth phase, people with serious illnesses are considered. In this case, the patient's age is no longer a criterion. Therefore, in the fifth phase, the following groups can be vaccinated:
• oncology patients in the stage of treatment of the disease,
• organ transplant patients,
• hematopoietic stem cell transplant patients,
• patients with chronic obstructive pulmonary disease in stage GOLD C, D,
• patients who have been treated for severe sepsis in the past who have at least twice had severe pneumonia in the past,
• patients with moderate to severe restrictive ventilation disorder,
• patients with chronic heart failure,
• patients after a stroke with permanent serious consequences,
• patients with severe pulmonary hypertension, severe restrictive heart disease
• patients with diabetes mellitus (diabetes) with an organ manifestation of the disease in at least two organs,
• patients with HIV in the stage of AIDS / late presenter
• patients with chronic renal failure
• patients with extreme obesity,
• patients with severe psychiatric illnesses at high risk of transmitting the infection to others,
• patients with liver cirrhosis,
• patients with severe metabolic diseases,
• patients with severe immune disorders,
• Patients with severe neurological diseases - sclerosis multiplex requiring treatment, , amyotrophic lateral sclerosis.
• patients with a mental, congenital or other disease with a significant reduction in cognitive function,
• Patients with severe rheumatologic, gastroenterological and other diseases that require biological treatment
• patients with severe haemocoagulation disorders,
• patients with a severe course of infectious diseases, such as tuberculosis.
The sixth phase is for patients with moderate diseases. The age of the patients is also not considered. These are patients:
• with oncological diseases in long-term remission,
• with oncological diseases overcome in the past,
• with second and third degree ESH / EHC hypertension,
• with ischemic heart disease, patients without myocardial infarction and stroke without major complications,
• with chronic obstructive pulmonary disease in stage GOLD A, B,
• treatment for bronchial asthma and severe forms of allergy and atopy ,
• with a mild degree of restrictive ventilation disorder,
• with diabetes mellitus with involvement of at most one organ,
• of the past obsolete sepsis or pneumonia.
• HIV positive, not in the stage of AIDS,
• with chronic renal failure (GF greater than 0.5 ml / s),
• with obesity
• with moderate psychiatric illness (higher risk of transmitting the infection to others),
• with chronic liver disease that is not in the stage of cirrhosis,
• with moderate metabolic disease, dispensary and not requiring substitution treatment,
• with a moderate immune disorder requiring dispensarization and substitution treatment,
• with moderately severe rheumatologic, chronic gastroenterological and other diseases do not require biological treatment
• with moderate haemocoagulation disorders.
In the seventh phase, teachers who are at least 55 years old can apply for vaccination.
In the eighth phase, the public comes to the fore - but those interested in vaccination must be over 55 years old.
In the ninth phase, all other teachers can be vaccinated.
In the tenth phase, people over the age of 45 are vaccinated.
In the last eleventh phase, anyone over the age of eighteen can apply for vaccination.
On February 11, another change took place, when the first teachers were vaccinated outside the list. Vaccination of teachers aged 55 or below began on 13 February. This is the first phase in which the Ministry of Education, in cooperation with the Ministry of Health, will provide school staff with the opportunity to be vaccinated against COVID-19 free of charge and voluntarily. Vaccination is carried out only with vaccines from AstraZeneca, for employees under 55 years of age, for the following groups:
• pedagogical staff of kindergartens,
• pedagogical staff of special kindergartens,
• pedagogical staff providing teaching at the first stage of primary school or in school children's clubs,
• pedagogical staff at special primary schools,
• pedagogical staff at secondary schools for pupils with disabilities,
• pedagogical staff at practical schools or vocational schools,
• pedagogical staff providing teaching of the ending years of secondary schools.
Due to the unfortunate press conference of prime Minister Matovic, who said in public that AstraZeneca is a bad vaccine and he prefers unregistered Sputnik V, 30% of teachers decided to opt-out of their vaccination, so the ministry changed the rules of vaccination. From 26th February, in addition to teachers and clerks, members of rail passenger transport drivers, public transport drivers, taxi drivers or public transport controllers can also get AstraZeneca vaccine.
These changes caused a chaos and national experts feared it would prolong the positive impact of vaccinations. Hence, as of 8th of March, new rules for vaccinations were approved:
• people should be vaccinated only according to age, with first groups being people aged 60
• people aged 69 and less will get AstraZeneca,
• People over the age of 70 will receive Pfizer and Modern,
• details about Sputnik vaccination are not yet available.
Ministry of Health (2020) Národná stratégia očkovania proti ochoreniu COVID-19 v podmienkach Slovenskej republiky (National vaccination strategy against COVID-19 in the conditions of the Slovak Republic). Available online from: https://www.health.gov.sk/Zdroje?/Sources/tlacove_spravy/covid-19/Strategia-ockovania-COVID-19.pdf
TASR (2020) Slovensko prijalo vakcinačnú stratégiu. Očkovať sa bude v štyroch vlnách (Slovakia has adopted a vaccination strategy. It will be vaccinated in four waves). Available online from: https://www.trend.sk/spravy/slovensko-prijalo-strategiu-postupneho-ockovania-proti-covid-19
PRAVDA (2021) Ministerstvo určilo, ako sa bude očkovať (Ministry decided new rules on vaccination). Available online from: https://spravy.pravda.sk/domace/clanok/575261-ockovanie-proti-covid-19-sa-bude-realizovat-v-11-fazach/
Ministry of Health (2021) COVID-19: Na očkovanie sa už môžu prihlásiť ďalšie vybrané skupiny (More groups can have a COVID vaccine). Available online from: https://www.health.gov.sk/Clanok?covid-19-27-02-2021-ockovanie-skupiny-dalsie
Folentová, V., Osvaldová, L and Barccíková, M (2021) Od pondelka sa má očkovať iba podľa veku, na rade sú už aj šesťdesiatnici, dostanú AstraZenecu ( From Monday, it is to be vaccinated only according to age, there are already 60s on the line, they will receive AstraZeneca). Available online from: https://dennikn.sk/2293611/od-pondelka-sa-ma-ockovat-iba-podla-veku-na-rade-su-uz-aj-sestdesiatnici-dostanu-astrazenecu/?ref=in
The Ministry of Health designated one hospital in the east part of Slovakia, one in central part of Slovakia and one in the capital of Bratislava, which will serve uniquely for the treatment of Covid-19. Other hospitals will provide separate pavillions for this kind of treatment.
There is an increased availability of telephone and e-mail consultation of health services in Slovak Republic since the outbreak of COVID-19. Health insurance companies provided a bonus payment for tele-medicine, in order to stimulate out-patient providers to continue service provision.