A case study of health sector reform in Kosovo

This paper examines the efforts to rebuild the health system in Kosovo after the United Nations established administrative control of the province in 1999. In many ways, Kosovo represented the beginning of a new form of international engagement in countries emerging from armed conflict. The international community assumed administrative control of the province, including control over the health sector. However, unlike other post-conflict states such as Afghanistan and Iraq, the implementing environment in Kosovo was favourable: high levels of donor assistance were dispersed, the majority of the population supported the military intervention, and the province had reasonably high levels of human capital concentrated in a small geographic area situated in Europe. Because of these factors, Kosovo is an optimal case study to examine the efficacy of international engagement in post-conflict societies, including health reform.Health reform is "sustained, purposive change to improve the efficiency, equity, and effectiveness of the health sector with the goal of improving health status, obtaining greater equity, and obtaining greater cost-effectiveness for services provided" [1]. In the analysis of health reform in Kosovo, the paper addresses two key questions:？ Policy Choices: What health policies and programmes were selected as part of the health reform effort? Why were these policies selected?？ Policy Outcomes: What factors impacted on the implementation of the health reform effort? What were the key successes and failures? Did health reform achieve its objectives?The Kosovo health reform program was initially lauded as a success given the evidence-based, organized, and orderly nature of the policy generation process [2]. However, the implementation of these reforms was more problematic than their creation, and the outcome of reform has not met its promise. The case study is of interest to policy makers considering reforming health systems in post-conflict or crisis-affec