The seconf phase of the project "Strengthening Nursing in Bosnia and Herzegovina"

Duration: December 2017 – November 2021

Generally, although a significant progress has been made in the Project’s Phase 1, there is much more to do in order to see the changes because most of the factors that were identified in the beginning as obstacles for nursing force development, still exist. We can summarize them in the following way:

• Nurses do not have enough authority, influence or power to affect decision making, during the patient care or at political forums. The entity level nursing associations still have a long way ahead before they become strong to have a say in policy creation.

• We still face a lack of data on the exact number, education profiles and the work nurses perform as the largest group of health workers, which makes difficult to plan their education and employment, as well as to assess the sustainability and effect of the development agencies’ support.   

• Most of the employed nurses in BIH have completed four-year high school education following curricula that differ in content and number of hours taught in different schools. Due to the increased migration trend of nurses, overproduction in this profession has been noted. At the same time, the health care system does not recognize university graduate nurse degree.

• The process of nursing studies curricula revision and use has just started at the universities in order to align them with the relevant EU directives. The lack of professors with PhDs in the field of nursing who teach at these institutions is still evident.

• The issue of alignment of private universities’ curricula with nursing studies with EU directives and more comprehensive application of the accreditation standards are issues that need to be tackled as well. 

• Although nurses provide services directly to patients they also do a lot of administrative work for doctors. Assessment, planning, implementation and evaluation of nursing care and other procedures done by nurses are rarely recorded as such; as consequence, the current system of financing in the health sector in BIH hardly recognizes their role in health care provision.

Therefore the Project in Phase 2 will continue with the support having as a goal better quality services available to all, especially to vulnerable and socially excluded groups. The Project will continue with its intervention simultaneously through three components, as pillars that carry the nursing profession.

Component 1:  Nurses professional environment

Nurses professional environment in Bosnia and Herzegovina will be improved via regulatory mechanisms which, among the rest,
include forming live register of nurses’ work force, developing standard operating procedures and obligatory nursing documentation for all levels of health care, expanding the existing list of nursing services and supporting development of nurses associations.

Component 2: Access to community nursing 

Standardized health care services provision recognized by health care system, in combination with improved access to these services for the whole population, especially vulnerable and socially excluded groups will help respond comprehensively to their health needs. Improved access to nursing services will be provided using the CN model tested during the project Phase 1. Adapted and officially recognized models will define the scope of community nursing services and the ways they will be offered, which will contribute to their recognition by the health system and ensure cooperation with other departments and organizations within and outside health sector.

Component 3: Public education in nursing

Quality service provision requires educated and competent nurses. That can be achieved by strengthening BIH education system, which will be accomplished by supporting the reform of secondary nurse education in public nursing high schools, aligning nursing study programs with EU standards, building teaching capacities by encouraging graduate nurses to enter the second and third education cycle, and developing strategies to introduce nurse specialist programs.

"This project means a lot more than just money. What does that
mean? People out there, that are alone, left behind, postpartum mothers and others are the real beneficiaries of the project. They are the most vulnerable groups and therefore every support to them is double worth.”

Director of Primary Health Care Centre Tomislagrad

„I would like to commend the nurse who came to my house at 10 o’clock in the evening to help me when I was in pain.”

Patient, Brčko

The greatest value of the project is that now we have educated nurses who are able to independently give support to the patients with chronic or difficult diseases, as well as dying patients in their homes.” 

Director of Primary Health Care Centre Bijeljina

“I feel more confident and equal with other team members. The patients are more satisfied because they see that we go through continuous education and they trust us more.”

Community nurse, Primary
Health Care Centre Prijedor

„The services provided by community nurses are standardized and we offer them in everyday work. We, the nurses, find it much easier to work now and the services we provide are of better quality.”

Community nurse, Primary Health Care Centre Tuzla

„In our institution the standard operating procedures for nurses are applied partially…I am convinced that if the services provided by nurses would be standardized at all levels of health care, the position, importance and status of the nurses would be significantly improved.”

Nurse, Primary Health Care Centre Bijeljina

„Clinical skills labs for us, the students,
who did not attend nursing high schools, have a very important role as we have the opportunity to practice procedures on sophisticated dummies even several times, in order to reach the necessary level of training enabling us to work with a real patient.”

Student at the Faculty of Medicine, nursing study program, Banja Luka