In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

EAPC Country of the Month - Bosnia and Herzegovina

December 2015

Report prepared by:

Prof. Mirza Dilic, MD, PhD, FESC, FACC
National CVD Prevention Coordinator of the Federation of Bosnia and Herzegovina/Bosnia and Herzegovina

Contact: email

 

 

Prof. Dusko Vulic, MD, PhD, FESC, FACC
National CVD Prevention Coordinator of the Republic of Srpska/Bosnia and Herzegovina

Contact: email

Documents to download

Short summary

Bosnia and Herzegovina is divided into two ‘Entities’: the Federation of Bosnia and Herzegovina and the Republic of Srpska, as well as the district of Brčko. In 1995, the General Framework Agreement for Peace in Bosnia and Herzegovina, which is known as the Dayton Agreement, ended the three and a half year war in Bosnia. This agreement also gave the responsibility for organising, financing and delivering health care to the two state entities and district Brčko. The health-care system is split into three levels: primary health care, secondary health care and tertiary care. 

Read the full report

Health care

Republic of Srpska: The health system is centralised, with planning, regulation and management functions held by the Ministry of Health and Social Welfare. Healthcare services are provided by public and private healthcare providers, at the primary, secondary and tertiary level.

Federation of B&H: The health system is governed by the Ministry of Health but the system itself is also decentralised, because the Federation consists of 10 (ten) Cantons, and each Canton has its own responsibilities for planning, organisation and providing health care for the population. The Federal Ministry of Health coordinates these activities.

Healthcare services are provided mostly by public healthcare providers, at the primary, secondary and tertiary level. Primary healthcare services are provided by family medicine practices, primary healthcare centres, and by pharmacies.

Read the full report

Risk factors

The Republic of Srpska:  Diseases of the circulatory system are the most common cause of death causing almost 47% of all deaths (2014). A health survey was conducted in 2011 including the population aged 18 and above who resided in the country for at least one year. According to the survey, 28.7% of the adult population smoke, one-fifth of the population is obese (21.6%), 61.2% have cholesterol blood levels (>5 mmol), 57.2% have increased blood pressure.

In the Federation of Bosnia and Herzegovina (2013) diseases of the circulatory system are the most common cause of death in Federation of Bosnia and Herzegovina causing almost 53% of all deaths in 2013. The overall CVD morbidity is approximately 11,500-12,000/100,000 inhabitants, and mortality of approx. 545/100,000/y counting population aged 18 and above. According to our data, 32.5% of the adult population smoke, 24.5% of the population is obese, 57.5% has total cholesterol blood levels > 5 mmol, and 54% has increased blood pressure.

Read the full report

Main actors

The main actor in the health system in the Republic of Srpska is the Ministry of Health and Social Welfare in cooperation with hospitals, primary health care centres and non-government organisations such as the Foundation of Health and Heart and Society of Cardiology Republic of Srpska.

In the Federation of Bosnia and Herzegovina the main actor in the health system for prevention is the Ministry of Health in coordination with Cantonal Ministries of Health. Preventive programs are provided through primary health care centres as well as secondary centres and also through outpatient clinics of Clinical University Centres in Sarajevo, Tuzla and Mostar. In addition, the Association of Cardiologists in Bosnia and Herzegovina also provides some preventive programmes.

There are national coordinators for cardiovascular disease prevention.

Read the full report

Prevention activities

Rebublika Srpska: The main preventive activities are organised in cooperation with WHO (Cardiovascular Risk  Assessment  and  Management) and with the World Bank (Strategic documents in tobacco control).

Several screening programmes have been launched since the year 2000: we conducted the Republic of Srpska Coronary Prevention Study (ROSCOPS) which  follows up on risk factors and treatment of CHD patients. We translated the ESC Guidelines on CVD Prevention in Clinical Practice, developed HeartScore B&H, and developed national guidelines for hypertension and hyperlipoproteinemia. We have organised WHD activities since 2000.

Federation of Bosnia and Herzegovina: There were several programs of CVD prevention, some of them led by the Federal Ministry and Institute for Public Health, some of them by the Cantonal health care systems, as well as by the Association of Cardiologists. The first screening programmes, started in 1995 just after the war halted, were conducted as the Sarajevo Vascular Study. Other preventive programmes are conducted by the Federal and Cantonal health care providers, mostly primary health care centres and family medicine centres. Even here the ESC Guidelines on CVD Prevention in Clinical Practice are translated and the HeartScore B&H programme introduced.

Read the full report

Cardiac rehabilitation

Patients groups involved in cardiac rehabilitation include patients after myocardial infarction and patients after various types of cardiac surgery and percutaneous coronary intervention (PCI). Cardiac rehabilitation is provided in hospitals: the early phase inpatient- as well as out-patient rehabilitation, mainly after the acute myocardial infarction (AMI).

Most of the patients after an acute coronary syndrome (ACS) and surgery are rehabilitated in special rehabilitation centers such as the rehabilitation center “Fojnica” near Sarajevo and the spa, "Vrucica“ Teslic. Access to cardiac rehabilitation after the AMI and/or cardiac surgery is almost universal (up to 60% of patients after an AMI or cardiac surgery) and it is covered by state health insurance funds.

Read the full report

Aims for the future

Republic of Srpska: Established Non Communicable Diseases (NCD) Action Plan 2015-2025, including 9 global targets and 25 indicators, developing a road map for CVD Prevention, focusing on smoking cessation and physical activity and use of national quality registers in the preventive strategies and new individualised models of cardiac rehabilitation.

Federation of Bosnia and Herzegovina: We plan to establish an overall national plan and programme of CVD prevention, including previously mentioned 9 global targets and 25 indicators, and to design a road map for CVD Prevention, focusing on smoking cessation, control of food intake, control of arterial hypertension, screening for de novo Diabetes Mellitus Type 2 (DM2T), increasing physical activity, increasing overall public awareness of CVD, and finally trying to develop a National CVD Registry.

Read the full report

 

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.