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Contries commentsParticular comments made by the reporters concerning the practice of gynæcology-obstetrics in their countriesFirst of all here are the comments made by the European delegates: In Albania:we consider that the training period of 4 years is too short – we wish to structure the subspecialties as well as the CME. We deplore the lack of a professional union. In Bulgaria:we complain about the insufficient remunerations in the public hospital, about aging technical support centres, about the enormous bureaucracy and about “backhander” payments posing legal problems. Proposed solutions: increase the percentage of GNP given over to health care, restructure the hospital sector, fix the price for medical acts, and clarify legislation. In Germany: we deplore the closures of small hospitals far from the towns. The big city hospitals are too many and often have budgetary difficulties. Conflicts with neighbouring disciplines are quite frequent (endocrinology, surgery, oncology, mid-wives). In Denmark: we deplore a too large gap between specialists in the private sector and in public hospitals. In Spain: insurance premiums are high, court cases are becoming frequent. Hospital salaries are too low. In France: the recruitment of young doctors in obstetrics is insufficient; professional insurance is abnormally high; expenses are heavy. The problemof professional insurance must absolutely be settled. In Greece: we deplore the overabundance of gynæcologists and the lack of their regulation, the administrative and fiscal bureaucracy, and the lack of beds for the training of gynæcologists poses problems. We complain about the impressive increase in the number of legal proceedings and the increase in compensation to victims. A political solution would be desirable, but the State hesitates to commit itself to this track. In Italy: we would like the specialist training to be better structured, the training services to be evaluated according to the EBCOG directives. The courts cases for medical liability are putting young doctors off the practice of obstetrics. Political solutions are desirable for diverse organisation problems. In Lithuania: the economic conditions are difficult. Specialists obtain insurance cover for civil professional Liability with difficulty. In the event of a problem, patients are partially reimbursed by the hospital or by the external consultation unit (or outpatients’ care). We would like an alteration to take place in the State or governmental policy in the way of an improvement in the status of doctors, better remunerations and professional insurance cover. In Luxemburg: there is an inrush of doctors from the neighbouring countries; they practice especially in external consultation and not in hospital. The clientele is becoming more and more demanding. Gynæcologists fearmedico-legal risks and are abandoning subspecialties such as uro-gynæcology, and ultrasound scans. State control is intensifying. There is no private sector. 17 Janvier 2008 In order to improve the situation, the number of gynæcologists should be regulated, state hold should be diminished and private initiatives encouraged. The subspecialties should be organised by the profession with clear accreditations. The increase in themedico-legal risks could be curbed by the “no-fault” system used in Scandinavia. In this systemthe prejudices suffered by the patients are taken on by the communitywhether there is a fault by the doctor or not. In the Slovak Republic: the big problem is the flight of specialists abroad as soon as they obtain their diploma. An improvement in the situation of specialists, in particular on the level of hospital salaries is necessary. In the Czech Republic: the financing of specialist training is insufficient. To finish, here are the comments of the African delegates: In Tunisia: the geographical spread of gynæcologists is not satisfactory: there is a lack of specialists in the rural sector. The feminisation of the profession is often accompanied by sexism on the part of the patients. The medical unions are in discussion with the National Health Insurance Office about the problem of fees. Concerning the four other African countries, the Central African Republic, Mali, Mauritania and Senegal, the main problem is the lack of health resources, the lack of specialists. The specialists are more often than not in the big towns and are cruelly lacking elsewhere. InMali:wewould like “unfortunate medica lmistakes” to be assessed and if necessary sanctioned. The population’s way of thinking is too often fatalistic. In Mauritania: we deplore the lack of specialist status, and of the planning of specialist training. The health service organisation is insufficient. Absenteeism in the public sector is at the expense of the private sector. To overcome the lack of gynæcologists and of mid-wives the government decided to create a body of auxiliary deliverers. This will probably enable the improvement in the safety of deliveries in the country. In the Central African Republic: there are too few gynæcologists. The CPT and the subspecialties are really secondary problems for the moment. Material difficulties are great and we ask for outside help. In Senegal: the majority of gynæcologists practice in Dakar. Far from the capital we deplore the lack of medical and paramedical staff. A decentralisation of health structures is desirable. Continuing medical training is to be developed. 
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