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Health systems across the world are faced with increasing health demands due to a rise in chronic diseases and demographic changes while experiencing financial pressures at the same time. Within this changing context, the large nursing workforce has invaluable potential to influence health outcomes by virtue of its number, its adaptive capacity, its understanding of care processes as well as its closeness to patients.

In Bosnia-Herzegovina (BiH), the current health system and education of health care professionals focus primarily on curative care, hospital care and physician-driven care, limiting the potential of the nursing workforce to respond to current and future health needs, particularly those of vulnerable populations. In addition, significant gaps in nursing competencies and practice negatively impact the effective operation of the country’s health system, weaken existing reform achievements (e.g. as in family medicine) and leave the country insufficiently prepared for the shifting health care needs and expectations of the population.

With theStrengthening Nursing in Bosnia and Herzegovina Project (ProSes) a Consortium of Fondacija fami (BiH) and Geneva University Hospital (HuG), aims to make a sustainable contribution to better health outcomes in BiH by improving the quality and effectiveness of nursing services, in particular at primary health care (PHC) level, and by increasing access to nursing services for vulnerable groups. While the project’s direct beneficiaries are the nursing workforce, and public and health institutions associated with the project, end beneficiaries are the health care service users, i.e. the general population, in particular vulnerable groups who presently have limited access to healthcare. In terms of geographical coverage, the project intervenes on a nation-wide basis, simultaneously in both entities of Bosnia-Herzegovina.

A system reform demands a broad variety of concurrent interventions related to the major intertwined system components. Thus, in order to achieve the project purpose of improved quality and access to nursing services, the project combines interventions in three areas: Component 1 – Nurse regulation and recognition; Component 2 – Community nursing expansion and outreach to vulnerable groups; Component 3 – Formal university-level nurse education.

ProSes proposes a long-term intervention in three phases, in collaboration with and supported by the Swiss Government. Implementation of the first 5-year phase began in October 2012.

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