Family Medicine Implementation Project
In Bosnia and Herzegovina (BiH), poverty and inequalities are an increasing concern. Because the country has recognized the link between development and health, the BiH health sector reform is addressing the issue of access to cost effective basic health services and has invested together with a number of donors in the implementation of a family medicine approach. The Swiss Agency for Development and Cooperation supported Family medicine implementation project (FaMI) has successfully demonstrated the feasibility of implementing family medicine at the primary health care level. During previous phases (2001-2007) of the project local institutions were involved so that project activities could move from a municipal to cantonal/regional level. Through FaMI project, 35 municipalities benefited from retraining courses in family medicine, reorganization, reconstruction and equipping of policlinics and medical practices. Throughout previous phases the project included increasingly more stakeholders in the project planning and implementation activities and reached a high level of local ownership in family medicine. Selected health institutions were contracted by the project to have them taking over project’s activities. This approach successfully facilitated a gradual transfer of the project activities to local institutions and partners.
Community Nursing Project (CN)

The need to provide a more comprehensive service package to the beneficiaries, particularly to the more vulnerable groups, requires adaptations in the composition of the FM team and its functioning. To meet the additional responsibilities of Family Medicine, the Ministry of Health and Social Welfare of RS decided to incorporate the existing community nurses into the FM network. The Federal Ministry of Health sees the community nurse as a key linkage with other sectors of the society, even though her/his place within the FM requires further definition. These nurses will link the FM with the community and coordinate the services for the vulnerable segments of the population. The community nurses should focus on home care services, including palliative care, patient education, health promotion and prevention, treatment follow-up, early detection of diseases and risk factors, and referral. The commitment of municipal authorities, and other local stakeholders/institutions, as well as the support and involvement of the community, will be essential to ensure a smooth integration of the community nurses and FM teams into home based care. 

As other professionals and networks are needed to complement FM in its work, new actors, such as social workers, mental health care providers, and other specialists will be associated to this team. The mechanisms for these associations will be discussed amongst all relevant parties.

Professionals from the social sector should be involved in the development of the curriculum for the training of community nurses. Other health providers should be actively involved in topics covering team building, coordination activities and their respective fields of work. This will also help the health providers to become familiar with the range of activities and services available in the social network and improve collaboration amongst all partners.

 
Community nursing Supervision workshop (photos)
Activities of the patronage nurse in Canton Sarajevo (photos)
 
Continuos Professional Development Project (CPD) &
Training of Trainers (ToT)

Primary health care should provide integrated, accessible, comprehensive and coordinated health care through FM teams. FM teams should address a large majority of personal health care needs, develop a long-term relationship with their patients, and practice in the context of the community. It is essential that the knowledge, skills and attitudes of health workers are constantly up-dated and broadened, so FM teams would maintain a satisfactory working standard level and improve quality. In order to achive this, the following activities are planned:

  • Develop plans for continuous professional development (CPD) integrated into existing health/educational structures,
  • Facilitate implementation of CPD with special focus on training capacity building,
  • Provide teaching equipment and material, and on-line data base for CPD,
  • Support the development of supervision, monitoring and quality improvement tools for CPD.
 
CPD in DZ Bijeljina (photos)
ToT in DZ Gorazde (photos)
 
More on Health promotion projects
Health Promotion Projects

Family medicine is characterized by comprehensive health care it provides to its patients. The continuum of health care spans from health promotion, via prevention to curative care. Patient-centred approach fosters building of health professional - patient trust.

Major risk factors of diseases in BiH are tobacco, poor nutrition, lack of exercise, substance abuse, unsafe sex, obesity. Other health issues that could be in focus are health behaviours during pregnancy, counselling on the importance of breast and uterus cancer early detection (breast self examination, regular pap tests), nutrition, exercise and dental health in children, youth and elderly, etc.

Public Health Institutes (PHIs) are the befitting institutions and have a leading role in prevention and health promotion programs. PHI in cooperation with PHC providers will identify health topics/problems that are to be dealt with. The Project will support PHIs to create detailed plan of health promotion activities and undertake coordination of different actors (NGOs, health and educational facilities, local community). 

Additional information:

WHO - Highlights on health in Bosnia and Herzegovina 2005
www.euro.who.int

PCU zdravstva - Health promotion strategy in Republika Srpska
www.pcuhealth.org

Dissemination

In an effort to improve the access and the quality of health services provided for all BiH population, one critical task of the project is to continuously assess and synthesize best practices, successful approaches and experiences to be able to share them with other cantons/regions that could benefit from these experiences and lessons-learned.  This information is also essential to reach policy-makers with clear recommendations and advocate for the replication of good-practice experiences on a macro-level for the benefit of wider population.  Dissemination plays an important role in coordination with other donors and will enable to reduce duplication of efforts.

Expected results:

  • Successful local approaches and experiences are systematically disseminated to policy and decision-makers, health care providers and beneficiaries.
  • Ownership at the level of national actors and health authorities is secured by means of the project steering bodies (working groups, steering board), and implementation of project activities through existing public structures, health and social sector, and civil society.

 

 
ICN Congress 2009 (photos)
VII symposium of nurses Teslic (photos)
 
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Family medicine implementation project (FaMI) - reconstruction and equipping
- LОCATIONS -

FAMILY MEDICINE IMPLEMENTATION PROJECT IN BOSNIA AND HERZEGOVINA 2001-2010
CONFERENCE "STRONG PRIMARY HEALTH CARE - THE FOUNDATION OF THE HEALTH SYSTEM"
BANJA LUKA FROM 23rd to 25th SEPTEMBER 2010
- SUMMARY -



The Ministry of Health and Social Welfare of Republika Srpska (RS), the Federal Ministry of Health of Bosnia and Herzegovina (B&H) and the foundation Fondacija fami, under the auspices of the Swiss Agency for Development and Cooperation, organized a three-day conference with international participation titled «Strong Primary Health Care – the Foundation of the Health System» in the building of RS Government in Banja Luka in the period from the 23rd to 25th September 2010.

The conference «Strong Primary Health Care – the Foundation of the Health System» was also the final conference of a ten-year Family Medicine Implementation Project (FaMI Project), that Fondacija fami carried out with professional assistance of the Geneva University Hospitals and through two project offices in the country, in Sarajevo and in Doboj. FaMI Project was implemented in cooperation with the Federal Ministry of Health of B&H, RS Ministry of Health and Social Welfare and other numerous partners and institutions, and financed by the Swiss Agency for Development and Cooperation.

In addition to RS Minister of Health and Social Welfare, Mr Ranko Skrbic and B&H Federal Minister of Health, Mr Safet Omerovicand, and their assistants, the conference was attended by B&H Minister of Civil Affairs, Mr Sredoje Novic, the Head of the Department of Health of Brčko District, Mr Admir Candic, the Minister of Health of Slovenia, Mr Dorijan Marusic, the Assistant Minister of Health of Montenegro, Ms Gorica Savovic, the Director of the Department of Health and Defenders of Zagreb, representatives of the Ministries of Health of Serbia and Macedonia, representatives of cantonal ministries of health from the Federation of B&H and directors of health facilities of RS and the Federation of B&H.

The objective of the conference was further improvement of primary health care through the gathering of experts in the field of health and other related fields, presentation of results, overview of experiences and lessons-learned, and promotion of good practices. The conference was attended by 201 participant from 105 institutions and organizations from Bosnia and Herzegovina, Slovenia, Croatia, Serbia, Montenegro, Switzerland and Turkey.

„Fondacija fami“ wishes to thank all the participants of the conference, presentors, moderators and the memebrs of the Organizational Board for their engagement in the past few month, strong logistical and organizational support, selection of and communication with important guests and competent speakers from the country and abroad, assurance of high-quality of presented topics, provocative, witty and professional moderation, comments and conclusions.


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Presentations from the conference with international participation "Strong Primary Health Care - the Foundation of the Health System"..... Day I!

Presentations from the conference with international participation "Strong Primary Health Care - the Foundation of the Health System"..... Day II!

Presentations from the conference with international participation "Strong Primary Health Care - the Foundation of the Health System"..... Day III!

Conclusions from the conference with international participation "Strong Primary Health Care - the Foundation of the Health System"..... read more!

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