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Health Care Reform in Bosnia and Herzegovina. Ranko Š krbi ć MD, PhD Minister of Health and Social Welfare Republic of Srpska. June 2 nd 2008, Halifax, Canada. Atlantic Ocean. Bosnia & Herzegovina. Serbia. Saguenay. Sept-Iles. Thunder Bay. Toronto. St.John. Ottawa. - PowerPoint PPT Presentation
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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 !