From time to time, until the crisis has passed, the HEPL blog series authors will be given the opportunity to provide short updates on their country/region’s continuing response to this worldwide catastrophe and their further reflections on those responses. Each update will be labelled accordingly with the original response at the bottom of each post.

HEPL blog series: Country Responses to the Covid19 Pandemic

Jeta Statovci, Heimerer College, Kosovo
Husein Reka, Asia Global Institute, Hong Kong University

Kosovo as the youngest nation in Europe has gone through a difficult period to rebuild its ruined health system since the 1999 war. It is also a country with one of the lowest levels of health expenditure in Europe with a government budget of Eur 240 million (2019 budget) and high levels of out of pocket payments (OOP) where nearly 80% of households incurred some sort of OOP.

As a new Government took power in February 2020 with an ambitious health reform agenda, the first and unexpected task for the newly appointed Minister of Health was dealing with a potential Covid-19 outbreak in the country. To further complicate matters, not long after the first cases of Covid-19 were registered in Kosovo, a no confidence motion was passed in the Kosovo parliament on the 26^th of March 2020. Facing a global pandemic, Kosovo was also confronted by political disruption with a change of government, and a new administration under Prime Minister Hoti was endorsed by the parliament on June 3^rd 2020.  

Bearing in mind this context, one would expect that Kosovo would not fair well in the fight against SARS-Cov-2 and the perceived weak health system would potentially collapse under the stress of Covid-19 cases. However, the effects initially were more than remarkable and surprising to many. Kosovo faired best with Montenegro in the West Balkans group of countries ranked among countries winning the battle against COVID-19. Data by Johns Hopkins University by the 2^nd of May rank Kosovo among countries with the lowest mortality rate per 100,000 inhabitants standing at 0.65. 

Timeline of measures

Considering the word trend, especially the occurring escalation of the situation in Italy and the devastating potential of COVID-19, Kosovo took preventative measures even before the first case. The education process stopped and travel bans were put in place for high risk countries, followed by a few other measures in relation to mass gatherings and public transportation. The first two cases of Covid-19 in Kosovo were registered on the 13^th March 2020 – one of them a young lady from Italy working for an NGO. Such events triggered the first local lockdown measures imposed by Government where two municipalities were put under quarantine (Klinë and Viti), followed by other measures such as full land border closure and a flight ban to and outside of Kosovo and formal quarantine for Kosovo citizens coming from abroad. Stricter measures of total lockdown with a limited time of free movement were announced on 23^rd March 2020. The Constitutional Court subsequently declared such decisions to be unlawful, as infringing citizens’ right to freedom of movement. The isolation period also has been deemed to be a significant burden upon businesses with a lasting impact on the economy, yet, considered in relation to the potential prevented fatalities, it was an effective measure with a positive net result from a public investment point of view.

Having reached the peak number of cases by the middle of April, where 79 additional cases were reported, the trend gradually began to decrease, while maintaining a relatively flat line of additional cases. A significant drop was noticed towards the end of April, where the number of new cases was in single digits.  The beginning of May reported a higher total of recovered cases in relation to total of people tested positive with COVID-19.  The relaxing of measures began from the 4^th to 31^st of May, following a plan organized in three phases. This was done to enable a gradual return to a new reality, and for people to learn to live with the virus. However, shortly after, numbers begin to sky rock following a steep upward trend.  A number of explanations can be pointed out, such as a quick reopening of the economy without proper testing of each phase and a lack of adaptation by businesses; low respect for recommendations on keeping distance, hygiene, and face masks; lack of COVID-19 legislation in place for proper enforcement of measures by competent authorities; low level of testing conducted in order to identify and isolate infected people (and hot spots), and followed by contact tracing; also a relatively high percentage of the population denying coronavirus existence.   

Following all of the above, the reported cases began increasing at an alarming rate. The relaxation of measures in turn relaxed the behavior of the people too quickly against the virus. The latest report accounts for 9,049 positive cases and 256 deaths; hence, a mortality rate of 2.8% among positive cases or 138.7 deaths per 1,000,000 population. This led to a return of state measures in order to put the situation under control, such as restrictions of movement in 13 municipalities from 22:30 to 05:00, restrictions on restaurants, a reduction to essential staff within institutions, restrictions on public and private gatherings, provision of negative PCR test mandatory for citizens of North Macedonia, Bosnia and Herzegovina, Serbia, and Montenegro to enter Kosovo, mandatory mask wearing for all outside of home etc.

Additionally, the Ministry of Health has adapted the health infrastructure to the increased volume of COVID-19 patients seeking health services, and employed an additional 200 health professionals within hospitals, as over 500 healthcare workers have been infected thus far. Considering the situation and volume of work, the government has approved a bonus payment of 300 EUR for public health personnel. Donor countries, the EU and other UN agencies vastly assisted in providing protective and other essential equipment to generate a physical resource pool for immediate use and future unforeseen circumstances.

As of 1^st July, the European Commission recommended a gradual lifting of travel restrictions for Western Balkan countries (WB6) into the Schengen area, yet to date most EU countries have decided to keep an entry ban in place or have complied with the recommendation but imposed quarantine upon returning. Global Level 4 Health Advisory has ranked Kosovo at level 4, under the do not travel category due to the impact of COVID-19.   Global cooperation, political collaboration, social unity, and partnership with institutions to respect the recommendations from the National Institute of Public Health are needed to help in addressing obstacles while aiming to control such an unprecedented situation.

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