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Reforming sanitary-epidemiological service in Central and Eastern Europe and the former Soviet Union: an exploratory study

George Gotsadze1, Ivdity Chikovani1*, Ketevan Goguadze1, Dina Balabanova2 and Martin McKee2

Author Affiliations

1 Curatio International Foundation, 37 d Chavchavadze ave, Tbilisi, Georgia

2 European Centre on Health of Societies in Transition and European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

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BMC Public Health 2010, 10:440  doi:10.1186/1471-2458-10-440

Published: 27 July 2010



Public health services in the Soviet Union and its satellite states in Central and Eastern Europe were delivered through centrally planned and managed networks of sanitary-epidemiological (san-epid) facilities. Many countries sought to reform this service following the political transition in the 1990s. In this paper we describe the major themes within these reforms.


A review of literature was conducted. A conceptual framework was developed to guide the review, which focused on the two traditional core public health functions of the san-epid system: communicable disease surveillance, prevention and control and environmental health. The review included twenty-two former communist countries in the former Soviet Union (fSU) and in Central and Eastern Europe (CEE).


The countries studied fall into two broad groups. Reforms were more extensive in the CEE countries than in the fSU. The CEE countries have moved away from the former centrally managed san-epid system, adopting a variety of models of decentralization. The reformed systems remain mainly funded centrally level, but in some countries there are contributions by local government. In almost all countries, epidemiological surveillance and environmental monitoring remained together under a single organizational umbrella but in a few responsibilities for environmental health have been divided among different ministries.


Progress in reform of public health services has varied considerably. There is considerable scope to learn from the differing experiences but also a need for rigorous evaluation of how public health functions are provided.