BELGRADE -- Milan, 43, has spent a month recovering from surgery to his leg in a Belgrade hospital. Like many Serbian patients, he worries not just about his medical condition but also about the healthcare system treating him.

"The food is terrible. We haven't had any meat or fruit since I got here. My family brings me extra food, clean pajamas and bed linen from home," he said, lying on his bed in a room with 10 patients packed into it instead of the planned six.

"Bathrooms aren't working. We're all using one, including the nurses. And there's no hot water," he complained.

Serbia's health system is crippled after a decade of sanctions and plummeting economic standards under Slobodan Milosevic as the old Yugoslavia broke apart in bloodshed.

Only a few hospitals were kept at high standards to provide care for the political elite and those who could afford to pay.

Debt-laden hospitals rely on outdated equipment, 75 percent of which is more than 10 years old, and most operate in appalling hygiene conditions in run-down buildings.

Corruption has infected the cash-starved system, as the low wages of medical staff fail to make ends meet and patients give backhanders to get better care.

Milan said his family was buying antibiotics for him as the hospital, Belgrade's emergency center, could not provide them.

"The nurses are nice to me, but my wife always gives them coffee or a few banknotes," he said.

Under-paid nurses and doctors are quitting the profession or going abroad, where there is a ready market for what are generally regarded as well-trained and talented staff.

Transforming the system is just one of the many challenges facing the reformers who ousted Milosevic in 2000.

Few people are raving about their record so far.

Infighting in the ruling 18-party bloc left the sector marginalized and without a minister for over eight months.

*** No Plan of Action *** "The government of Serbia has no credible, coherent strategy and plan of action to rationalize, restructure and reorient the health system toward improvement of quality and uniform access to services..." the World Bank said in a paper issued in April.

"The system suffers from chronic shortage of funds and lack of financial accountability, accumulating large payment arrears.

It is not sustainable and requires reforms..." it added.

Serbia's health spending is the lowest in the region at $110 per capita -- $30 of which is paid directly by patients themselves, buying medicines and services in private medical institutions which have mushroomed over the past decade.

Luigi Migliorini, the head of the World Health Organization's Belgrade office, said the Serbian health system looked fine on paper but needed to be modernized.

He said the network of institutions designed in the 1980s was good but low quality services from primary medical centers meant patients were swamping costly, specialized clinics.

"The dark period with bad habits lasted too long," he said. "Serbia's health care is like a skeleton with good bones where flesh and muscles must be rebuilt."

Foreseeing a painful and long reform, international experts say the sector needs a new strategy, a thorough reorganization and an injection of cash from foreign donors.

About one fourth of some $750 million Serbia spends in the sector goes on medicines. Rationalizing drug consumption alone would free significant funds, Migliorini said.

*** Bitter Pill*** The emergency center director, surgeon Mihajlo Mitrovic, said there was no real will or consensus among politicians to swallow the bitter pill of health reform.

He admitted patients were often told to buy medicines and other materials needed for their treatment or operations as the hospitals could not provide them.

"Those who cannot afford to buy it are deprived of necessary treatment...we have to improvise and sometimes even use out of date material to provide the service needed," Mitrovic said. "Sometimes we ask the family of a deceased patient to leave drugs they bought for their loved one for another patient."

The arrival in June of Doctor Tomica Milosavljevic as health minister brought some hope for Serbia's 130,000 health workers.

"Healthcare is a top priority in 2002," Milosavljevic told Reuters. He said the sector was burdened by $20-30 million in external debts and billions of dinars more owed at home.

But he acknowledged problems were as much about organization as about money. "Without changes, this bottomless pit could easily absorb billions of dollars without producing any significant effect," the minister said.

He said his priorities included better quality care, equal access to services and improved primary health centers. He also announced the introduction of an ombudsman for patients' rights and a body to monitor the quality of work and services.

Milosavljevic is under pressure from trade unions for a pay rise. But he asked for more patience from professionals, whose enthusiasm has kept the system alive over the past decade.

"I know salaries are low and insufficient for a decent life. But we cannot afford higher wages due to a meager budget."

Vesna, a 30-year old nurse working at the emergency center, has just received her monthly salary of 9,200 Yugoslav dinars ($147), most of which will go on unpaid bills.

Her boss, a surgeon at the surgical intensive care unit where 15 patients need permanent attention, earns 15 times less than his predecessor who left eight years ago for Germany.

Vesna is one of few experienced nurses still at the unit.

Five left in June for better-paid and easier jobs.

But Vesna too has now found a new job, in a clothes shop with a monthly salary of 12,000 dinars and no nightshifts. "My son, who starts school this autumn, cannot wait," she said.