Table 3.

Kosovo-Dartmouth Partnership: Lessons Learned

  • Change in culture from specialty care to primary care will take time and attention from the Ministry of Health.

  • Time lags for funding impact project momentum, supply chain, and reinforcement of new practice patterns.

  • Lack of system-wide health statistics on which to base our outcome data makes true outcome data very difficult to collect and rely on.

  • Care processes that do not include systematic follow-up or preventive care reflect ongoing cultural change challenges that will take time and attention from providers and the healthcare system of the country.

  • Changes in leadership within the family medicine centers led to interruption of progress in improvements made and threatened to move the family medicine centers back to previous standards.

  • Lack of funding for the healthcare system overall, including for supplies and professional salaries, has had a tremendous impact on the project. Professionals are unable to live at current salary levels and must have second/third jobs to survive. This had led to many requests for additional payment for work done within the project and increased tension. It has also led to a lack of basic supplies of equipment and medications necessary to care for the population.