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Report prepared by:
Prof. Mirza Dilic, MD, PhD, FESC, FACCNational CVD Prevention Coordinator of the Federation of Bosnia and Herzegovina/Bosnia and Herzegovina
Prof. Dusko Vulic, MD,PhD,FESC,FACCNational CVD Prevention Coordinator of the Republic of Srpska/Bosnia and Herzegovina
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.
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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 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.
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 at least one year. According to the survey, 28,7% of 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 11.500-12.000/100000 inhabitants, and mortality of approx. 545/100000/y counting population aged 18 and above. According to our data, 32,5% of 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.
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.
Rebublika Srpska: 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 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. Screening programmes have started in 1995, the first one, just after the war halted, was 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.
Patients groups involved in cardiac rehabilitation are: 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 center 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.
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 National CVD Registry.
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.
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