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

Atlantic Ocean Bosnia & Herzegovina Serbia Atlantic Ocean Bosnia & Herzegovina Serbia

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

BOSNIA AND HERZEGOVINA Two entities – FBIH, RS & District Brčko Total population 3. BOSNIA AND HERZEGOVINA Two entities – FBIH, RS & District Brčko Total population 3. 8 mill Area 51, 129 km 2

Bosnia and Herzegovina Country Profile Republic of Srpska Federation of B&H Area : 24 Bosnia and Herzegovina Country Profile Republic of Srpska Federation of B&H Area : 24 857, 2 km 2 Population: 1 487 785 Population per 1 km 2 : 59, 9 Birth rate/ 1000 population : 7, 7 Death rate / 1000 population : 9, 3 Infant mortality rate : 4, 3 Area : 26 110, 5 km 2 Population: 2 328 359 Population per 1 km 2 : 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 Cooperation and Coordination in the Field of Health Care in Bosnia & Herzegovina

Roles and responsibilities Council of Ministers (8 Ministries) Ministry for Civil Affaires: Coordination in 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

Challenges of the Health System • Demographic trends → • • ↓ natural increase Challenges of the Health System • Demographic trends → • • ↓ natural increase ↓ natality rate Aging population Migration Geographical distribution of population 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

Health Care Reform in RS Key documents defining the health care reform in RS: 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 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: q q Primary Health Care Reform Main reasons for the primary health care reform: q q q Unequal access to health care Inefficient delivery of health care services Inadequate health care financing Inadequate structure of human resources Aging population

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

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

Family Medicine Model Emergency unit Centre for Social Work Centre for Mental Health Centre Family Medicine Model Emergency unit Centre for Social Work Centre for Mental Health Centre for Basic Rehabilitation FM team Primary Health Care Center Laboratory X-ray FM team Dentistry

Development of Human Resources for PHC • • Family Medicine in undergraduate studies Program 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 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

Implementation plan Start: 4 Pilot sites (Laktasi, Celinac, Doboj, Banja Luka) DZ Laktasi (16 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 Education Banja Luka Centre for FM Education Banja Luka

Centers for Mental Health Implementation program started in 1996 (WB) FBH 38 RS 16 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

Centres for Mental Health Centres for Mental Health

Centres for Basic Rehabilitation Implementation program started in 2002 (Japan, Canada) FBH 38 RS 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

Centres for Basic Rehabilitation Centres for Basic Rehabilitation

CIDA projects: 1. Balkans Primary Health Care Policy Project 2. Balkans Youth and Health 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 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 Priority Goals in the Field of Primary Health Care and Public Health Promotion of Healthy life styles (focus on the vulnerable groups) Reorganization of Primary Health Care with focus on Family Medicine and Community services Indicators of measurement of youth health Enhancement and planning of resources in PHC (human resources, installment, equipment) New payment mechanisms (capitation) Goals System of surveillance of communicable diseases Prevention and control of mass nonccommunicable diseases Improvement of monitoring and evaluation Rational and effective use of pharmaceutical products Improvement of quality opf Health Care through modern procedure (EBM – Evidence Based medicine)

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

2. Balkans Youth and Health Project Youth – Oriented Legislation in RS • National 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

2. Balkans Youth and Health Project Youth – Oriented Legislation in FBH • National 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)

3. Collaboration with Public Health Associations Public health association Non-profit, voluntary organization dedicated to 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

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

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