Like the rest of the social systems in Serbia, it has come under severe economic pressure since the 1909s. Serbia had taken over a state health system from Yugoslavia, in which all workers and employees as well as a large part of the self-employed paid a fixed portion of their wages (12.3%) into the state health insurance fund, from which the free provision of medical care for the population was financed. As a result of the economic decline, the system became unstable, with 2 million contributors and 7 million insured. The health fund accumulated a large deficit, the unsustainable funding of free services was increasingly supplemented by direct payment for services by the insured. Healthcare salaries fell dramatically,
In the first half of the past decade, the Serbian government began to reform the health care system with the help of the World Bank. In this way, transparency in the health system, especially in the private sector, has been increased significantly. The expenditure of the insurance fund could be stabilized. A modern medical concept that focuses on preventive medicine was introduced. The structural problems of the Serbian health care system have remained. This mainly relates to the increasing funding gap caused by the public health insurance system, which is due to an aging population and a low level of employment. In addition, the health insurance contributions of 20% of the population (public sector employees and their dependents) are paid from the state budget. While public financing of the health care system decreased, the share of private expenditures in total health care expenditures rose to 42.4% in 2017. These are direct payments from citizens, often due to structural corruption. Added to this is the increasing migration or recruitment of doctors and nurses to Western Europe, especially to Germany.
Overall, public spending on health care in Serbia is relatively high with comparatively poor performance. Health expenditure in 2019 was 9.1% of GDP, close to that of the richest EU member states (Germany 11.5%, Austria 10.3%). The number of hospital beds and doctors per 1,000 inhabitants, on the other hand, at 5.7 and 3.1, respectively, were significantly below the figures for EU countries with comparable expenditure levels (Germany 8.3 and 4.2).
There were 2,700 people infected with HIV registered in Serbia in 2016. Other relevant infectious diseases in Serbia are tetanus, diphtheria and hepatitis A and B.
The challenges of the corona pandemic
The corona pandemic is a major challenge for the Serbian health system. As for most countries in the world, the first problem was the lack of protective equipment and corona tests, as well as the capacity limits of intensive care medicine. Since 1990, 16% of intensive care beds in Serbia have been dismantled. Ventilator capacities remained unclear at the beginning of the crisis as the government declared the number a state secret.
The measures taken by the Serbian government therefore focused on the rapid procurement of ventilators, through purchases and donations, as well as protective equipment and tests. In addition, additional bed capacities of 3,000 and 1,000 beds were created at the Belgrade Exhibition Center and at the Novi Sad Exhibition Center. At the same time, the government decided to increase health expenditure by 100 million euros. This includes a 10 percent wage increase in the health care system – which, however, only corresponds to the amount of the wage cuts made in recent years. Finally, the government banned the export of certain medical goods.
Due to the massive decline in the number of new infections in the course of April and the lifting of the state of emergency and lockdown at the beginning of May, the additional bed capacities in Belgrade and Novi Sad were reduced again.
Serbian society shows strong conservative traits, which were considerably reinforced by the nationalist war policy of the 1990s. A special expression of these conditions is the precarious social position of sexual minorities to this day. The legal protection has improved significantly in recent years, in particular through an anti-discrimination law passed in 2009, and so has the way the media are dealt with members of the LGBT community has improved. Nevertheless, the sexual minorities continue to see themselves exposed to discrimination, while the improved legal protection is hardly implemented in practice to this day. Organized resistance comes primarily from right-wing extremist Serb groups such as “Dveri”, “Naši” and “1389” – but also from the Serbian Orthodox Church. The most prominent expression of this self-assertion struggle for minority rights is the annual struggle for the Gay Parade. After 2001, a gay parade only succeeded again in 2010 in Belgrade to hold. Around a thousand participants were protected from several thousand members of right-wing extremist groups and football hooligans by 5,000 security forces. In the following three years, most recently in September 2013, the Interior Ministry banned the Belgrade Gay Parade for “security reasons” – despite massive pressure from the EU.
In autumn 2014, again under strong pressure from the EU, a gay parade took place in Belgrade for the first time. A massive police presence prevented serious incidents during the parade. Ministers from the Serbian government, opposition politicians and Western diplomats also took part in the march, in which an estimated 1,000 to 1,500 participants took part. The day before, several thousand right-wing extremists had demonstrated against the parade.
However, two weeks earlier there was an attack on a German LGBT activist who was attending a conference in Belgrade and who was critically injured in the attack.
In contrast, the Gay Parade 2015, the Gay Parade 2016 and the Gay Parade 2017 ran without major incidents, and also in the past two years.
The nomination of the previous Minister for Public Administration, Ana Brnabić as the new Prime Minister of Serbia by the newly elected President Vučić in June 2017 meant a turning point in the history of the LGBT community in Serbia. She thus became the first lesbian Prime Minister of Serbia. This then set a first political signal in September with their participation in the Gay Parade 2017. The decision was received differently by the Serbian public: Serbian LGBT activists welcomed the appointment in principle. Sections of the parliamentary opposition put the historic step into perspective by what they believed was the political intentions of the president. Some minor,
As in the previous year, Serbia’s first lesbian Prime Minister took part in the Gay Parade for the second time in 2018. However, the Prime Minister’s second appearance was controversial among LGBT activists. Last year it made announcements to improve the situation of gays and lesbians. Numerous activists who wanted to prevent the Prime Minister’s participation complained that none of the promises had been implemented. The criticism was renewed at the Gay Parade 2019. In 2019, the Prime Minister became a mother after her partner gave birth to a child – another milestone in the history of the LGBT community in Serbia.
In 2020 the Gay Parade had to be canceled due to corona or it was postponed to the coming year. In the middle of September the 10th Pride week took place, which this year had the corresponding motto – “Solidarity within your own four walls”. In this context, the activists once again criticized the government for continuing to fail to implement most of its reform promises. In 2019, it was legally made easier for trans people to have their gender portrayed in personal documents without medical alignment. But in all other areas, such as the introduction of equal partnerships and their legal equality with marriage, there has been no progress.