Multi-donor Trust Fund: Health Sector Strengthening in Bosnia and Herzegovina

Even though formally committed to reforms and EU accession, BiH lacks the financial and technical ability to ensure adequate approaches and undertake demanding reform processes. Reflecting BiH's complex political constitution, health insurance and health services are highly fragmented. The health sector is expensive, inefficient, and suffering from poor service quality, limited skills, and accountability. Inefficient institutions and weak financial management have contributed to the accumulation of significant budget overruns and arrears, threatening the fiscal sustainability and quality of service delivery. Insufficiently defined standards for medical treatment and profession leads to unnecessary duplication of services and cost increase. The patients' care and quality of services remain inadequate, particularly regarding non-communicable disesases (NCDs).

A key challenge ahead is to continue the health care system transformation with long-term strategic guidance and political commitment.

Supporting health reform efforts is the foundational element to sustain and increase effects of all Swiss supported health interventions in BiH and ensure a strong role in policy dialogue.

Entity Ministries of Health, Health Insurance Funds, Public Health Institutes

Health Care Facilities

Hospital networks, primary and secondary level healthcare service providers, healthcare managers

NGOs and local communities

Ultimately, all BiH citizens, incl. vulnerable groups will access to and benefit from more efficient and patient-oriented care.

Outcome 1: Health care providers are able to deliver gender sensitive health care services of improved quality, focusing on non-communicable diseases.

Outcome 2: Health care providers and institutions introduce more transparent and accountable procedures and enhance accounting and procurement systems.

Outcome 3: Citizens are actively engaged in monitoring the effects of the health care reform process and setting the agenda on primary health care and health financing reforms.

Expected results:  

• Knowledge and skills about more efficient NCDs' prevention and treatment updated in line with contemporary medical practices
• The expanded role of primary care and nurses' roles in NCDs' treatment promoted and advocated
• Clinical documents and regulations updated to ensure people-centered primary health care
• More accurate financial reimbursement for evidence-based care of NCD patients calculated
• Health care accounting protocols adapted to the treasury system requirements
• Regulations drafted on pricing and benefits package and training conducted on public financial management to improve efficiency of spending in the health sector
• Ensured and facilitated social dialogue between the government, civil society and patients
• Health care facilities conducted a self-assessment of transparency and accountability of their work and public engagement through a gender-differentiated citizen feedback
• Health care authorithies, local communities and CSOs implement joint communication and media campaigns to gain citizens' support

Results from previous phases:  

Baseline for Phase 1:

• The primary public health challenge in BiH is reducing NCDs as they are estimated to account for 80% of the country's annual deaths and dominate the overall burden of disease and disability
• Weak preventive and primary care: There is scope to strengthen preventive and primary care, thereby reducing unnecessary use of hospitals
• Inefficiencies in hospital care: Unavoidable in-patient hospital care is provided in ways that can be made more efficient
• Lack of effective financial controls: Irrespective of efficiency, there is a lack of effective financial controls to prevent over-spending in hospitals
• Weak accountability of the health systems to citizens: no monitoring of patients satisfaction rates is done, citizens aren't engaged in providing feedback in service design and delivery planning
• Weak incentives, accountability and training: Performance frameworks that would enable managers and clinicians to improve quality of care and financial balance are not well developed
• Under-funded health care systems: BiH's health care systems are under-funded for the level of service they aim to provide

Entity governments

Development Partners: EU Delegation, other international donors active in the health area