Health Care Reform in Bosnia and Herzegovina

1. Health Care Reform in Bosnia and Herzegovina Ranko Škrbić MD, PhD Minister of Health and Social Welfare Republic of Srpska June 2nd 2008, Halifax, Canada

2. Atlantic Ocean Bosnia & Herzegovina Serbia

3. Saguenay Sept-Iles Thunder Bay Toronto St.John Ottawa It’s still daylight in California Halifax Québec Montréal Those light are Boston, New York, Philadelphia and Washington. Detroit Dallas Puerto Rico Houston Miami Mexico City Havana Port-au-Prince

4. BOSNIA AND HERZEGOVINA Two entities – FBIH, RS & District Brčko Total population 3.8 mill Area 51,129 km2

5. Republic of Srpska Area : 24 857,2 km2 Population: 1 487 785 Population per 1 km2 : 59,9 Birth rate/ 1000 population : 7,7 Death rate / 1000 population : 9,3 Infant mortality rate : 4,3 Federation of B&H Area : 26 110,5 km2 Population: 2 328 359 Population per 1 km2 : 89,2 Birth rate/ 1000 population : 9,3 Death rate / 1000 population : 8,0 Infant mortality rate : 9,5 Bosnia and HerzegovinaCountry Profile Epidemiological profile: noncommunicable diseases

6. Cooperation and Coordination in the Field of Health Care in Bosnia & Herzegovina

7. Roles and responsibilities Council of Ministers (8 Ministries) Ministry for Civil Affaires: Coordination in the field of Health and Social Care International collaboration Entity Governments (16 Ministries, each) Ministries of Health: Full responsibility of the Health Care of population (Regulatory, Policy, Planning, Financing, Implementation, Coordination, Monitoring, Evaluation…) Ministerial Conference on Health, since 2007

8. Challenges of the Health System ↓ natural increase ↓ natality rate Aging population Migration Geographical distribution of population • Demographic trends → • Legislative and regulatory changes in EU • Socio-cultural changes • Unequal access to health care • Health system response to real health needs of population • Vulnerable groups

9. Health Care Reform in RS Key documents defining the health care reform in RS: • Health Policy and Strategy Program in RS by the Year 2010 • The RS Primary Health Care Strategy • Secondary and Tertiary Health Care Strategy in RS • Policy ofQuality of Health Care in RS • National Drug Policy • Mental Health Policy • Blood Safety Strategy until 2015 • Strategy for Control of Iodine Deficiency in RS • Strategy for tabacco control in RS

10. Health Care Reform in FBH Key documents which defining the health care reform in FBH: • Resolution on Health Policy for all citizens of BH • Federal Policy on quality and protection of Health Care • Federal Strategy for tabacco control • Federal Program for prevention of alcohol and drug abuse and other addictions • Federal Strategic Plan for development of Primary Health Care • Federal Strategic Plan for Health development 2008 – 2018 • Federal Strategy for prevention of HIV/AIDS • Federal Strategy for prevention of Iodine Deficiency • Federal Drugs Policy

11. Primary Health Care Reform Main reasons for the primary health care reform: • Unequal access to health care • Inefficient delivery of health care services • Inadequate health care financing • Inadequate structure of human resources • Aging population

12. Primary Health Care Reform The health care reform aims to: • Introduce the family medicine model • Establish new mechanism for health care resources allocation and introduce new provider payment mechanisms • Enhance the organization, planning and management of health institutions • Develop and implement national health policies, strategies and programs

13. Family Medicine Strategy Implementation plan Monitoring and supervision Initial situation analysis Quality syst./ accredit of FMTs Family medicine implementation strategy HC regulations Contracting/ Payment mechanisms Change management FMT information system FM teams training

14. Family Medicine Model Emergency unit Centre for Social Work FM team Centre for MentalHealth Primary Health Care Center FM team Centre forBasicRehabilitation FM team Laboratory X-ray Dentistry

15. Development of Human Resources for PHC • Family Medicine in undergraduate studies • Program of Additional Training (PAT) • Specialization in family medicine • Change management courses • Training in health management • Continuous medical education • Medical Chamber licensing • FM association

16. Development of Human Resources for PHC in RS Family medicine (FM) team: 1 doctor + 2 nurses Standards: 2.000-2.500 Inhabitants per FM team Number of FM teams needed for RS ≈ 700 Queens University program (WB) Training program: PAT, FM specialization, management Registration of population Promotion and public media

17. Implementation plan Start: 4 Pilot sites (Laktasi, Celinac, Doboj, Banja Luka) DZ Laktasi (16 teams): FM concept fully implemented in 2002 Training centers in RS (Banja Luka, Doboj, Foca) App. 430 FM teams already trained Full implementation 2010/2011 Agency for Accreditation 78 FM teams already accredited

18. Centre for FM EducationBanja Luka

19. Centers for Mental Health Implementation program started in 1996 (WB) FBH 38 RS 16 Training programs for doctors and nurses Benefits: • Reorientation from clinical psychiatry towards community based mental health • Better accessibility • Les hospitalization / stigmatization • Faster reintegration in community • Better cost/benefit; cost/effectiveness outcomes

20. Centres for Mental Health

21. Centres for Basic Rehabilitation Implementation program started in 2002 (Japan, Canada) FBH 38 RS 23 Training programs for doctors and nurses (Queens University) Benefits: • Reorientation from hospital rehabilitation towards community based rehabilitation • Better accessibility; increased number of patient treated • Les hospitalization • Faster reintegration in community • Better cost/benefit; cost/effectiveness outcomes

22. Centres for Basic Rehabilitation

23. CIDA projects: • Balkans Primary Health Care Policy Project • Balkans Youth and Health Project • Project for Strengthening the Roll of the Civil Society in the Field of Public Health

24. 1. Balkans Primary Health Care Policy Project Components in B&H: • Health Human Resources Planning, Management and Governance • Education of Health Professionals • Education for Health Human Resources • Regulation, Accountability and Quality • Coordination, Knowledge Translation and Communication (Regional)

25. Priority Goals in the Field of Primary Health Care and Public Health

26. Priority Activities in the Field of Primary Health Care and Public Health CIDA CIDA C CIDA CIDA CIDA

27. 2. Balkans Youth and Health Project Youth – Oriented Legislation in RS • National Youth Health Policy in RS (2008 – 2012) • Adopted by RS National Assembly • Strategy for Monitoring of Opiate Drugs and Containment of Opiate Drugs Abuse in the RS (2008 – 2012) • Adopted by RS National Assembly • National Strategy for Youth Health in RS • In process

28. 2. Balkans Youth and Health Project Youth – Oriented Legislation in FBH • National Youth Health Policy in the FBH 2008 • Federal program for prevention of alcohol and drug abuse and other addictions 2002 • The National Strategy of Supervision over Narcotic Drugs, Prevention and Suppression of the Abuse(in public discussion)

29. 3. Collaboration with Public Health Associations Public health association • Non-profit, voluntary organization dedicated to strengthening the role of the civil society in the field of public health ↑ Capacity and competences in the field of public health ↑ Capacity for development and implementation of policies and programs related to public health

30. Expected Outcomes Contemporary and efficient healthcare system tailored to meet the needs of population

31. First Balkans Primary Health Care Conference Banja Luka, RS, BiH, 2007 Thank you for your attention !