About the situation in the health care system, how to improve it and how to stop the departure of medical workers from the Republika Srpska, we talked with the current Minister of Health and Social Welfare of the Government of Republika Srpska, Alen Šeranić who was elected for the best Minister in 2018, as the Minister of Science and Technology of the Government of Republika Srpska.
TST: What are the most significant projects in the field of health that you plan to implement during your mandate?
ŠERANIĆ: There are several building projects planned. Reconstruction of the University Clinical Centre of the Republic of Srpska will continue with Cardiac Surgery Clinic, Maternity building and the Infectious Diseases Clinic. In the following years we are going to get a modern Medical Campus next to the Clinical Centre with Faculty of Medicine and Medical School.
New Psychiatric Clinic will be constructed in Banjaluka, while the psychiatric hospitals in Sokolac and Modrica will be reconstructed. Construction of the new hospital in Doboj has already started. We are also preparing reconstruction of the University Hospital Foca. All these large-scale works will lead to a better hospital infrastructure.
We want to focus on the prevention of diseases and the promotion of healthy lifestyles, as the best way to improve the overall health of the population. In order to achieve this goal, we need to change the organization of public healthcare facilities, mainly in primary health sector.
The Republic of Srpska Government has recently adopted the Action Plan for Prevention and Control of Noncommunicable Diseases in the Republic of Srpska for the period 2019-2026. We do intend to strengthen the existing and initiate new disease prevention and health promotion programs, focused both on individuals and populations at risk. The programs will need to tackle different risk factors for the noncommunicable diseases, including smoking, physical inactivity, alcohol consumption and unhealthy nutrition – with high intake of the salt, fat and sugar. This will require extensive involvement from the inside and the outside of the health sector in a whole-government approach, bringing together a wide range of relevant stakeholders.
TST: How do you assess the current health situation?
ŠERANIĆ: The main public health challenge in the Republic of Srpska is reduction of noncommunicable diseases: heart disease, stroke, cancer, diabetes and chronic respiratory disease. These diseases are leading causes of death. Together, they account for 80% of the annual deaths. They dominate the overall burden of disease and disability, as do the risk factors that contribute to them, such as high blood pressure, tobacco use and unhealthy nutrition. Addressing the risk factors and the diseases is the foremost public health priority in the Republic of Srpska.
As in other health systems in south-eastern Europe, we’ve have recently witnessed reappearance of the vaccine-preventable communicable diseases, such as measles or mumps. Vaccination is the best prevention for these diseases. It is unfortunate to see how the anti-vaccination groups have worldwide harnessed the power of social media to spread unproven, false and misleading information and raise fear among the parents. Returning communicable diseases – low vaccination coverage. When parents choose not to vaccinate their children, they directly expose them to significant risk. We will need to open additional communication channels to provide accurate information to parents.
During my recent visit to the Medical Center in Celinac, a small primary health care unit, I witnessed how much direct communication with patients in terms of immunization is important, as they have managed to increasethe level of immunization coverage among children up to 98 percent. This can be a good example for all health care institutions and it is a good sign that the changes are possibleif we all make an effort.
TST: How do you try to strengthen the health system in the Republic of Srpska?
ŠERANIĆ: In addition to tackling the noncommunicable diseases, we need to deal with the challenge of assuring financial sustainability of the health system. There are significant arrears in the Republic of Srpska’s health system, that threaten to endanger the continuity of the health services provision. This is a complex problem. Any deepening of the arrears could undermine the trust of health service users in our health facilities. We need to take an immediate action with full involvement of all partners, including the financial institutions.
The analysis of the existing arrears is ongoing. It will guide us in finding the right approaches to close the arrears and prevent the health system going into arrears again. We are currently considering several priority actions. Additional sources of financing will need to be identified to close the existing arrears, to improve safety and quality of health services and to ensure creation of attractive jobs in the health system. Inclusion of the public healthcare providers and Health Insurance Fund of the Republic of Srpska in the treasury system will help to better manage their expenses and to prevent new arrears. This approach has already been tried in two facilities and we intend to expand it over the next three years to all public healthcare providers. In parallel, we will need to take different measures to ensure that we are gettinga better value for the available money.
Government of the Republic of Srpska has recently adopted long-term Strategic Development Plan for Health Insurance Fund of the Republic of Srpska, which will be implemented by the Fund, Ministry of Health and Social Welfare of Republic of Srpska and public healthcare facilities.
TST: In December 2018, you were proclaimed the best minister in the Government of the Republic of Srpska. How much does that recognition mean to you?
ŠERANIĆ: It means a lot. I have always tried to perform my work and duties responsibly, outspokenly and wholeheartedly. Knowing that the citizens recognise the efforts, motivates me for putting more energy into my work. At the same time, the public trust is also an obligation – I am expected to lead one of the most demanding sectors in improving its performances in a way thatsatisfies the health care needs and demands of the whole population of the Republic of Srpska. After all, measure of success for every individual in the health system, including me of course, is patients’ satisfaction.
TST: In recent years, a growing number of health workers have left the Republic of Srpska, and this trend continues. How to prevent it?
ŠERANIĆ: People are the backbone of any health system, as healthcare services cannot be provided without trained professionals. Emigration of the skilled healthcare professionals is an issue not only for the Republic ofSrpska’s health system, but also for the neighbouring systems and countries; even globally. The globalisation of the labour market for healthcare professionals has led to some new trends, such as emigration from the EU countries to other developed countries. Easing of the entry criteria for health professionals by some of the EU countries contributed to the emigration of health professionals from the Republic of Srpska.
We are aware that experienced mid-career doctors and nurses are the main groups of health professionals that emigrate. These include professionals that are in shortage in other countries, particularly specialists like anaesthesiologists. To avoid having similar shortages in the Republic of Srpska, we need to listen to the needs and concerns of our health professionals and to continuously work on improving working conditions for them. The Ministry of Health and Social Welfare in the Republic of Srpska Government endeavours to considera gradual increasing ofthe level of salaries in the public healthcare facilities, but this will depend on the availability of additional funding. Better recognition of nursing profession, particularly the graduated nurses is needed too.
We also intend to tackle the issue of professional advancement and opportunities for participation in research and scientific work. Our professionals need to be provided with training opportunities, and service delivery models have to be adjusted to enable them to utilize skills and procedures learned abroad. Further, we need to retain the best students in our health system. Such practices are already in place in the University Clinical Centre of Republic of Srpska, but we need to expand them to other providers. I am aware that each health professional makes its own decision on where to practice, but it is the responsibility of the Ministry of Health and Social Welfare to lead the improvement of the working conditions towards those that motivate them to decide to remain in the Republic of Srpska.
Author: Danka Savić