EU funded projects in BiH

Public Health

PROJECT DETAILS

Sectors Education, employment and social policies
EU Acquis chapters Consumer and health protection
Programme Funding Year 2007, 2008
Value €4,355,912
Periods of implementation 2009, 2011
Locations BANOVIĆI, GRAČANICA, GRADAČAC, KALESIJA, KLADANJ, LUKAVAC, SREBRENIK, TUZLA, ŽIVINICE, ČELIĆ, DOBOJ-ISTOK, SAPNA, TEOČAK, BANJA LUKA, BIJELJINA, BILEĆA, KOZARSKA DUBICA, GRADIŠKA, BROD, NOVI GRAD, ŠAMAC, BRATUNAC, ČAJNIČE, ČELINAC, DERVENTA, DOBOJ, GACKO, HAN PIJESAK, KALINOVIK, KOTOR VAROŠ, LAKTAŠI, LOPARE, LJUBINJE, MODRIČA, MRKONJIĆ GRAD, NEVESINJE, PRIJEDOR, PRNJAVOR, ROGATICA, RUDO, KNEŽEVO, SOKOLAC, SRBAC, SREBRENICA, ŠEKOVIĆI, ŠIPOVO, TESLIĆ, TREBINJE, UGLJEVIK, VIŠEGRAD, VLASENICA, ZVORNIK, SARAJEVO-CENTAR, HADŽIĆI, ILIDŽA, ILIJAŠ, SARAJEVO-NOVI GRAD, NOVO SARAJEVO, SARAJEVO-STARI GRAD, TRNOVO (FBiH), VOGOŠĆA, GRUDE, ŠIROKI BRIJEG, LJUBUŠKI, POSUŠJE, ČAPLJINA, ČITLUK, JABLANICA, KONJIC, NEUM, PROZOR, STOLAC, RAVNO, ODŽAK, ORAŠJE, DOMALJEVAC-ŠAMAC, BIHAĆ, BOSANSKA KRUPA, BOSANSKI PETROVAC, CAZIN, KLJUČ, SANSKI MOST, VELIKA KLADUŠA, BUŽIM, BOSANSKO GRAHOVO, TOMISLAVGRAD, GLAMOČ, KUPRES, LIVNO, DRVAR, BUGOJNO, BUSOVAČA, DONJI VAKUF, FOJNICA, GORNJI VAKUF - USKOPLJE, JAJCE, KISELJAK, KREŠEVO, NOVI TRAVNIK, TRAVNIK, VITEZ, DOBRETIĆI, FOČA - USTIKOLINA, GORAŽDE, PALE - PRAČA, FOČA, BREZA, KAKANJ, MAGLAJ, OLOVO, TEŠANJ, VAREŠ, VISOKO, ZAVIDOVIĆI, ZENICA, ŽEPČE, DOBOJ - JUG, USORA, PALE, BRČKO, BERKOVIĆI, NOVO GORAŽDE, DONJI ŽABAR, ISTOČNA ILIDŽA, ISTOČNI DRVAR, ISTOČNI MOSTAR, ISTOČNI STARI GRAD, ISTOČNO NOVO SARAJEVO, JEZERO, KOSTAJNICA, KRUPA NA UNI, KUPRES (RS), MILIĆI, MOSTAR, OSMACI, OŠTRA LUKA, PELAGIĆEVO, PETROVAC, PETROVO, RIBNIK, STANARI, TRNOVO (RS), VUKOSAVLJE

SUMMARY

The assistance was dealing with strengthening of the capacity of the public health functions at all levels in BiH, fulfilment of international obligations through support to the implementation of existing health promotion policies, improvement of national preparedness to public health threats and the systems for health monitoring and disease surveillance. In addition, the projects were dealing with financial matters in the health care system through improvement of national financial reporting system NHA (national health accounts) in line with EUROSTAT requirements; the groundwork for an outputs based hospital payment system, and the development of health information capability in hospitals. The aim was to build a solid foundation for major hospital payment reform in order to improved hospital effectiveness and the delivery of better value by the BiH hospital sector as a whole introducing DRG (Diagnostic Related System). 1. Institutional and capacity building of public health systems in BiH in order to increase its readiness to response on public health threats (pandemic, bio terrorism, natural disasters etc.); 2. Enhancement and improvement of assessment of global health of BIH population and system of reporting on communicable diseases; 3. Improvement of national financial reporting system NHA. 2.2 Project Purposes 1. Strengthen the Sector for Health of Ministry of Civil Affairs to be able to fulfil BiH international obligations as well as those in light to SAA and also related to cooperation with EU institutions in the health field, as well as to enhance its coordination capacities in regard to public health functions. 2. Strengthening and modernisation of entity PHIs and the Public Health Department in Brcko District to be able to perform quality collection, monitoring and evaluation of health related data. 3. Support entity PHIs in implementation of existing relevant policies and strategies focused on public health promotion and disease prevention according to the New Public Health approach with aims to improve national preparedness to public health threats. The purpose of the project is to support health care reform in BiH through harmonization of relevant public health legislation with the EU directives and regulations in order to enhance evidence based planning of health care system. The following project results are anticipated: 1. Institutional and capacity building of public health systems in BiH in order to increase its readiness to response on public health threats (pandemic, bio terrorism, natural disasters etc.); 2. Enhancement and improvement of assessment of global health of BIH population and system of reporting on communicable diseases; 3. Improvement of national financial reporting system NHA.

RESULTS

Results contributing to public health reform and international obligations: A situational analysis and assessment of the Public Health Institutes in BiH, which revealed gaps in skills and training needs for staff, the need for strengthening communication, networking, and quality management was conducted including the New Public Health approach. The BiH Ministry of Civil Affairs (MoCA) Sector for Health increased capacity in functions of planning, support and coordination through analysis of health legislation and strategies in line with approximation to EU regulations, introduction of New Public Health elements, and public health data management. New approaches were introduced, such as advocacy for “Health in All Policies”(HiAP), influencing determinants of health and combating inequalities in health. “Health in All Policies” (HiAP) and inter-sectoral cooperation are an important element of New Public Health. Innovative methods for financing of public health interventions were defined and recommendations were provided in regard to the taxation of tobacco use, the introduction of project based financing and fundraising within the Diaspora. A Guidebook for the most prominent elements of New Public Health, as a reference document and training material for health workers was drafted. The Guidebook provides an overview of the concept of ‘New Public Health’ and its key approaches, with main orientation to inter-sectoral cooperation and health promotion. Using the Guidebook, the training was organised for the representatives of health institutions. Some 34 participants have been trained in topics related to health promotion and disease prevention in order to strengthen capacities related to the development of a New Public Health Approach in BiH.The project carried out a campaign for raising awareness of the population towards their own health promoting a healthy lifestyle, physical activity and healthy nutrition. Two events were organized: Health Days in Sarajevo (08-10.06.2011) and Health Day in Banja Luka (30.09.2011). An assessment of availability and comparability of data in both entities and Brčko District was carried out according to the World Health Organization Health for All (WHO HFA) list, as well as according to Eurostat. An integrated list of indicators was developed based on the WHO Health for All, Eurostat and the list of ECHI indicators. For the public health database of BiH, the selected indicators were classified by using unique and agreed codes. The database structure corresponds to the WHO Health for All database and ECHI health database of the European Union. The data dictionary (metadata description) contains all relevant information on each indicator,and it has been developed for all 89 indicators available for data collection. It reflects the international definitions of indicators, international database codes and purpose/rationale of the indicator. presents the sources of data in both entities and Brčko District. Persons involved in the decision-making process in public health were identified, as well as the data/information they need and the decision-making process in Sector for Health MoCA, Entity Ministries of Health, DH BD and Public Health Institutes and trained. Result of the trainings is increased knowledge on New Public Health and clarity on the role of staff in timely submission and transformation of data into user friendly public health information. Public health data for entire Bosnia and Herzegovina will be collected and analysed in Sector for Health of the BiH Ministry of Civil Affairs. The BiH Agency for Statistics is legally in charge of representation of Bosnia and Herzegovina in international statistical institutions, the BiH Ministry of Civil Affairs will collect public health statistical data needed for international reporting of BiH towards Eurostat, and deliver the data to the BiH Agency for Statistics. In regard to reporting to other international organisations and institutions (WHO, UNICEF, etc.), the BiH Ministry of Civil Affairs will continue reporting, thus fulfilling international obligations Bosnia and Herzegovina took over in the area of public health reporting. A technical task force for Causes of Death (COD) was established. The Task Force (TF) developed and introduced a unified certificate of death on entity level and in BD and the increased of the quality of coding of causes of death, considering the EU Implementation Measures.The death certificate was drafted, in line with the requests of Eurostat. A manual for certification of cases of death was drafted for special practical use by coroners in BiH. As a result of the entry of public health data for 2009 the Health Report for BiH 2009 was drafted and adopted by the BiH Ministry for Civil Affairs and ministries of health. The Health Report gathers in one place all relevant data related to health status of the population, health services and health care resources, including some demographic and socio-economic indicators in BiH. Information and communication technologies and coordination of Sector for Health (SfH) Ministry of Civil Affairs BiH, in regard to preparedness for international reporting on public health data and regulatory issues were analised . This analysis also covered the assessment of available data and information communication in public health in both entities and Brčko District. The existing software infrastructure and public health data acquisition methods were assessed. Following the basic architectural requirements, a Portal for data reporting was established. Options for upgrading of the portal and its localisation have been developed and agreed. Appropriate manuals were developed for users, administrators and developers. Local trainers were trained in administration, programming, entry of new indicator definitions. Employees of MoCA and entity institutions were trained in the application of software. A certain number of employees were additionally trained in database and reporting systems development. The portal was installed in Brčko District, PHI FBiH, PHI RS and MoCA, user accounts for each level were created and portlets for each indicator were developed. The list of 89 indicators has been completely covered with portlets for data entry. Output tables for the 18 pilot indicators have been fully developed in 4 languages (English, Bosnian, Serbian, and Croatian). In total 171 output-table reports have been developed for the total list of 89 indicators. A situational analysis and assessment of the quality of Communicable Diseases (CD) notifications in BiH, which revealed the gaps in skills and training needs for staff, as well as the need for strengthening communication, networking, and quality management. The assessment also covered the Internationa Health Regulations (IHR) indirectly, revealing limitations to effective use of information on notified infectious diseases. Epidemiologists from all PHIs, Federal Ministry of Health, Ministry of health and Social Welfare of the Republic of Srpska and MoCA were informed on process of responding to Pubblic Health Event of International Concern (PHEIC), using approaches and standards from EU and WHO. Among the main outputs were a database on collection of notifiable infectious diseases in two versions, one fully Internet resident and one local database, plus a database to collect information on epidemic outbreaks. Full set of documents contained in a Standard Operating Procedures package (Case Definitions, Critical Values, SOPs) were drafted. New set of indicators, Standard Operating Procedures for managing epidemiologic outbreaks and in analytical and reporting procedures using mostly hands on, participative and non-prescriptive approaches were identifed and defnied. Reports on quality of collected data on notified CDs, on IHR core capacities and on dynamics of infectious diseases in BiH were developed in cooperation. Among main outputs was the report characterising quality of data on notified infectious diseases by administrative units, as well as a report on IHR core capacities. Results of both reports were used in shaping the training needs both for epidemiologists as well as for IHR Local Focal Points. Results in providing assistance to financial reform: 1. Diagnostic Related Groups (DRG)using Australian model (AR-DRG) training and coding activities for all BiH acute hospitals (31) including entity and cantonal Health Insurance Funds (HIFs)provided and in total 1360 people received the trainining. 74 coder trainers trained through special TOT courses. Technical specifications for the development of the BiH, AR-DRG grouper drafted and the grouper developed for the Windows environment to suit the requirements of the BiH. AR-DRG grouper was tested and validated according to technical protocols and commissioned in beneficiary sites as agreed. Manual for the BIH Grouper software was drafted. Training conducted to relevant HIF IT staff on grouper operations. Data from all RS hospitals is being grouped using the grouper in the RS HIF; and grouper housed in the Federal HIF is functioning and is being used for grouping by the Mostar HIF. Methodology for setting DRG prices and their use in the hospital payment model was devloped. DRG cost-weights developed for application in BiH Comparative analysis of available DRG output and financial data to ascertain efficiency of BiH hospitals Simulated hospital inpatient budgets based on the available DRG and financial data. Recommendations made on the importance of purchasing, methods to improve efficiency and the inclusion of quality as a measure of hospital performance. Hospital contract based on payment for performance and the DRG payment model drafted including the main conditions of contract and three appendixes. Training related to the use of the contract and the monitoring of performance as measured by DRGs including auditing, undertaken for HIFs. The contract has been accepted by the beneficiaries and the RS is currently using a contract version which is similar to the draft – with one exception however, namely the budget-share approach. The FBiH may need to go through a process of consensus building to have the contract adopted by all cantons although Tuzla, Mostar and Sarajevo HIFs introduced DRGs into their contracts with hospitals as a tool to measure and monitor hospital activity. ICT survey of hospitals and HIFs undertaken and results analysed and reported Strategy delivered to upgrade ICT capacity in the health sector including recommendations on phased development. Legal report which includes discussion of relevant issues including: BiH legislation related to DRG implementation; special issues related to the FBiH; and the ability to hospital boards to make changes to improve efficiency. Business planning paper including the framework for the writing of business plans including recommendations related to quality of care and the wider use of same-day procedures drafted. Action Plan submitted which sets out recommendations for the further development of the DRG based hospital payment system over the short and medium term focusing on: data accuracy, audits, DRG costing and contracting. National Health Accounts: Guidelines for collecting information and analysis of financial expenditures in health for the purpose of NHA developed, NHA databases and NHA tables for period 2004-2011 for RS, FBiH, BD and the level of BiH developed, The list of health care providers is developed and implementation of International Classification of Health Providers (HP) was initiated New questionnaires and reporting forms in order to improve existing data sources develped. Web portals of key institution enhanced with NHA tables and key indicators of health expenditure, On the job training on compilation of NHA tables and training on usage of NHA data for indicators of financing and expenditures in health implemented, Staff in the Agencies for statistics, ministries of health and HIFs trained on usage of NHA for monitoring, evaluation in health policy and usage of NHA data for indicators of financing and expenditures in health. National Health Accounts Report for BiH for period 2009-2011 was drafted and approved my Ministry for Civial Affaris and Ministers of Health.