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FAMILY MEDICINE in BOSNIA AND HERZEGOVINA (Completed
end of 2007)
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With
CHF200 per capita, health care expenditures of Bosnia
and Herzegovina (BiH) are among the lowest of Europe.
Despite these serious financial constraints, the health
care system has been dominated by expensive specialist
care. Even for common problems that can be addressed at
the primary care level, patients are referred for
specialist treatment. Under the current health reform
plans, the government of BiH is working on reversing the
proportion of specialists to primary care providers from
70 to 30%, primarily by retraining already practicing
doctors and nurses in family medicine.
To support these health
reform plans,
Fondation PH Suisse and the Geneva University Hospitals
(HUG), initially in 1997 with private funding, and
since 1998 with support of the Swiss Agency for
Development and Cooperation (SDC) have assisted the
government in its efforts.
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Approach
The Family Medicine project (FaMI) has
developed various strategies over the years to assure
the quality and sustainability of the family medicine
services and to provide access to family medicine
to as large a target population as possible.
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Retraining of doctors and nurses -
From 1998 to 2005, a total
of 570 doctors and nurses have been trained in
family medicine in several modules scheduled
throughout the academic year. Training has always
focused on the doctor-nurse team to assure that
nurses assume a more supportive and effective role
in patient counselling and basic nursing services
and free the time of the doctor for clinical care.
In addition, the curriculum emphasizes prevention
and health promotion to improve the health status of
the population and curb health care costs.
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Training of local trainers (TOT)
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To transfer the responsibility of
training from Swiss consultants to BiH trainers, a
training curriculum, including Family Medicine
content and adult education methodologies, has been
developed. A cadre of project-trained local
trainers now plan and implement all retraining
courses under the oversight of the project staff.
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Rehabilitation of family medicine
practice sites - The past
war has left health clinics (DZs) and practice sites
(ambulantas) destroyed, in bad repair, and/or
without essential equipment. In partnership with
the local health authorities, the project has
contributed toward the rehabilitation and equipping
of DZs and ambulantas.
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Assistance to the implementation of
good family medicine practices and standards
- The project has assisted retrained doctor-nurse
teams in the implementation of good family medicine
practices, including registration of patients,
implementation of patient scheduling systems, and
patient files. Trained local supervisors and
implementers problem-solve with the newly trained
teams. With doctors’ and nurses’ chambers, medical
faculties, and DZ, professional continuing education
systems are being put into place to keep the family
medicine teams up-to-date.
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Sustainability
- The responsibility for retraining, implementation,
and monitoring is being gradually transferred to the
local partners to assure sustainability and
expansion.
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Next Steps
Based on the positive
results of the Programme, the SDC is supporting Fondation
PH Suisse and HUG to expand the Programme until September 2006.
It is planned to train additional doctors and nurses and
to rehabilitate and equip a larger number of primary
care clinics.
If you would like to
know more about this programme or to contribute to it, please
contact us.
Fondation PH Suisse - Partnerships in Health
60 Route des Coudres, CH-1298 Céligny, Switzerland
Tel: +41 (0) 22 776 78 81/87/89
Fax: +41 (0) 22 776 79 27
Email: contact@partnershipsinhealth.ch
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