Quo vadis SANEPID? A cross-country analysis of public health reforms in 10 post-Soviet states.
BACKGROUND
The public health systems of the post-Soviet states have evolved from the san-epid system, which dominated public health practice throughout the former Soviet Union. Since independence, reforms have taken different directions. This article provides a cross-country comparison of public health reform processes and contents in 10 post-Soviet states.


METHODS
The study is descriptive and comparative, based on a literature review of the major health databases, the Health Systems in Transition (HiT) volumes and grey literature. Search terms included terms on public health, the san-epid services and organizational reforms in one or several post-Soviet states.


RESULTS
Public health reforms have varied greatly: some countries have preserved the san-epid structure, some have built structures in addition to the san-epid system, and others have set up a new public health infrastructure. Traditional "functions" of the former san-epid system, such as vaccination, are still more advanced, while health promotion and intersectoral collaboration are less developed.


CONCLUSIONS
Critical self-evaluation, implementation of performance measurement and rigorous external research will prove essential in identifying strengths and weaknesses of past reforms and learning for the future.
Maier
Claudia B
CB
European Observatory on Health Systems and Policies, Rue de l'Autonomie 4 B-1070 Brussels, Belgium. cma@obs.euro.who.int
Martin-Moreno
José M
JM
D001136:Armenia; D001382:Azerbaijan; D005846:Georgia (Republic); D018166:Health Care Reform; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D007623:Kazakhstan; D007707:Kyrgyzstan; D008966:Moldova; D011315:Preventive Medicine / Q000458:organization & administration; D011635:Public Health Administration; D002094:Republic of Belarus; D012800:Siberia; D014455:Ukraine; D014610:Uzbekistan