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

Health Care Reform in Bosnia and Herzegovina

Ranko Škrbić MD, PhDMinister of Health and Social Welfare

Republic of Srpska

June 2June 2ndnd 2008, Halifax, Canada 2008, Halifax, Canada

Bosnia & Herzegovina

Atlantic

Ocean Serbia

Saguenay

Ottawa

Sept-Iles

Mexico City

Québec

Montréal

St.John

Those light are Boston, New York, Philadelphia and Washington.

Toronto

Detroit

Miami

Havana

Puerto RicoHouston

Dallas

It’s still daylight in California

Thunder Bay

Port-au-Prince

Halifax

BOSNIA AND HERZEGOVINABOSNIA AND HERZEGOVINA

Two entitiesTwo entities – FBIH – FBIH, , RSRS & &DDistrict istrict BBrčkorčko

Total population 3.8 millTotal population 3.8 millAArea 51,129 km2rea 51,129 km2

Bosnia and HerzegovinaCountry Profile

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

Epidemiological profile: noncommunicable diseases

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

MINISTRY OF CIVILAFFAIRS OF

BOSNIA AND HERZEGOVINA

Ministry of health andsocial welfare of Republicof Srpska

Ministry of health of Federation of Bosniaand Herzegovina

Department of health and other services ofBrčko District

MINISTRY OF CIVILAFFAIRS OF

BOSNIA AND HERZEGOVINA

Roles and responsibilities

Council of Ministers (8 Ministries)Ministry for Civil Affaires:

Coordination in the field of Health and Social CareInternational 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

Challenges of the Health System

• 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

↓ natural increase↓ natality rateAging populationMigrationGeographical distribution of population

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 of Quality 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

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

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

The health care reform aims to:Introduce the family medicine modelEstablish 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

Primary Health Care Reform

Family medicine

implementation strategy

Implementation planMonitoring

and supervision

Change management

FM teams training

Contracting/Payment

mechanisms

FMT information

system

Initial situation analysis

HC regulations

Quality syst./ accredit of

FMTs

Family Medicine Strategy

Primary Health Care Center

LaboratoryX-ray

Emergency unit

FM team

Dentistry

Centre forBasic

Rehabilitation

FM team

FM team

Centre for MentalHealth

Family Medicine Model

Centre for Social Work

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

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, managementRegistration of populationPromotion and public media

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

Centre for FM EducationBanja Luka

Centers for Mental Health

Implementation program started in 1996 (WB)FBH 38RS 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

Centres for Mental Health

Centres for Basic Rehabilitation

Implementation program started in 2002 (Japan, Canada)FBH 38RS 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

Centres for Basic Rehabilitation

CIDA projects:

1. Balkans Primary Health Care Policy Project

2. Balkans Youth and Health Project

3. Project for Strengthening the Roll of the Civil Society in the Field of Public Health

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)

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

Promotion of Healthy life styles

(focus on the vulnerable groups)

Promotion of Healthy life styles

(focus on the vulnerable groups)

Indicators of measurement of

youth health

Indicators of measurement of

youth health

System of surveillance of communicable

diseases

System of surveillance of communicable

diseases

Prevention and control of mass non-

ccommunicable diseases

Prevention and control of mass non-

ccommunicable diseases Rational and

effective use of pharmaceutical

products

Rational and effective use of pharmaceutical

products

Improvement of quality opf Health

Care through modern procedure (EBM – Evidence Based medicine)

Improvement of quality opf Health

Care through modern procedure (EBM – Evidence Based medicine)

Improvement of monitoring and

evaluation

Improvement of monitoring and

evaluation

New payment mechanisms (capitation)

New payment mechanisms (capitation)

Enhancement and planning of resources

in PHC (human resources, installment,

equipment)

Enhancement and planning of resources

in PHC (human resources, installment,

equipment)

Reorganization of Primary Health Care with focus on Family

Medicine and Community services

Reorganization of Primary Health Care with focus on Family

Medicine and Community services

GoalsGoals

Priority Activities in the Field of Primary Health Care and Public Health

activities

expansion of the famility medicine model to cover the whole territory of RS

education and training of menagers

human resources planning and development

strenghtening the capacity of proffesional orgranisations

preparation and realisation of the National strategy for youth health in RS

implementation of youth friendly health services

provision of services in the field of mental health

in the community

prevention and control of noncommunicable diseases

surveillance of infectious diseases

activities

C

CIDA

CIDA

CIDA

CIDA

CIDA

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

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)

2. Balkans Youth and Health Project

3. Collaboration with Public Health Associations

Public health associationNon-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

Expected Outcomes

Contemporary and efficient healthcare system tailored to meet

the needs of population

First Balkans Primary Health Care ConferenceBanja Luka, RS, BiH, 2007

Thank you for your attention !