By acting promptly, coolly and transparently, Tuzla Canton’s Health Minister, Dajana Colic, and her colleagues belied the clichés about Bosnian inefficiency – and ensured that worst-case scenarios about the spread of COVID-19 were never realised.
It was on Friday, 27 March, that Dajana Colic, the Health Minister of Bosnia’s Tuzla Canton, received a phone call from the laboratory at the city’s University Clinic. For almost a month she had received daily updates on the results of COVID-19 tests. Two out of 23 that day had been positive. They were the first to be confirmed in the canton, which is home to nearly half a million people.
Immediately after the call, Colic, drove to the cantonal public broadcaster. On the way to the studio, her colleagues were forwarding all known details about the two cases. As she sat in front of the camera, she realised that she had not put on her protective mask and gloves.
This, she promised herself, would not happen again until the pandemic was over. During the interview, she said epidemiologists were informing and isolating the individuals. They were going to conduct interviews and trace their contacts. “Citizens should not panic since this was an expected development. Let us do our job and you, please, just stay at home,” she said.
Soon after Colic left the studio, two news stories went viral across the canton and the rest of Bosnia. The first was that one of the confirmed cases was a nurse working in one of Tuzla’s healthcare facilities. The spread of the virus inside hospitals was something Colic dreaded most.
The second was an interview with Nermin Salkic, a professor at the medical faculty in Tuzla with international experience. He projected that within weeks, Bosnia could face 380,000 hospitalised cases and 38,000 deaths.
“Our health system has its limits,” Salkic said during his interview with country’s most popular evening news programme, warning: “We should not fool ourselves but use the two-week-long window of opportunity and prevent this explosion.” That evening, Colic took a deep breath and told herself that she had “to take it one day at a time” – something her father told her repeatedly throughout the 1992-5 war in Bosnia.
Dajana Colic is not a politician to attract international media attention. Born in 1979 in Lukavac, she belongs to a generation of left-wing politicians in Bosnia too young to remember the communist Yugoslavia led by Josip Broz Tito. She was barely six months old when Tito died in May 1980.
In the midst of the Bosnian war, she attended Tuzla medical high school. After, she went to Sarajevo to study dentistry. In 2005, with a degree in her pocket, she moved back to work in a hospital in her hometown of Lukavac, some 15 kilometres west of Tuzla.
Her political career began in October 2016, when she was elected a member of Lukavac’s municipal council. She joined politics to change things, after “realising that, as much as I resisted, politics governed every part of my life”, she said. In early May 2017, she was appointed director of the hospital where she worked in Lukavac.
After studying its financial records, she concluded that “things could not continue as before”. The hospital was accumulating debt. She started to take “difficult decisions”. Among them was not extending the short-term contracts of 26 staff. They were not happy and complained, so she was invited to explain her decision to the municipal council.
Clashes between different interest groups are a feature of any society. Reconciling those clashes in a political process that determines the public interest is central in every democracy.
To generate policy outcomes that citizens recognise as legitimate, the process has to be genuinely open and inclusive. In Bosnia, the public interest is often not determined in a process that takes into account different interest groups. Instead, unwelcome groups are often silenced. This then usually leads either to decisions that benefit narrow interests or to political paralysis reflected in an inability to take difficult decisions.
In a seven-minute speech to the municipal council, Colic fiercely defended her decision and what she considered the public interest. On one side, she explained, there was the interest of 26 people to keep their jobs and monthly salaries of around 20,000 euros.
On the other side was the interest of 45,000 citizens of Lukavac who depended on the hospital for their medical care. These services were at risk because the debt to suppliers was around 150,000 euros. As some invoices had not been paid for eight months, the suppliers were threatening to stop supplying the hospital, to open lawsuits and to ask the authorities to block the hospital’s bank account. Meanwhile, new medical equipment was needed and some of the existing equipment had not been serviced for the second year in a row.
Colic concluded that the public interest was better served by not extending the 26 contracts and by using the saved funds to assure the supply of medical material. The municipal council was not convinced; 18 days later Colic was forced to quit as director of the Lukavac hospital. The 26 contracts were signed by her successor.
It was an experience she would not forget. In September 2018, when Colic campaigned in Bosnia’s general elections, she warned that “our healthcare system is on the brink of collapse”.
In these elections, she received six times more votes than two years earlier and in July 2019, she was appointed one of two women ministers in the government of Tuzla Canton. She took over running the second largest health system in Bosnia, with 5,500 employees and an annual budget of around 120 million euros, serving nearly half a million citizens.
By early December 2019, Colic had managed to “put together a full overview of the healthcare system in Tuzla Canton”. In an interview with a local TV station she concluded that there were “problems, but not everything is dark”.
Communication within the healthcare system between different institutions was a huge problem, but her biggest worry was “overburdened family doctors” who “on average perform 80 examinations per day”.
This meant that too little time went into preventative health care, in her view the most important task for the healthcare system, as “we are an old and sick population”. Colic warned that without prevention, the burden on the healthcare system would only increase in future. Already there was a significant increase in respiratory and, to a lesser extent, in cardiovascular diseases, she said. This would require “a broader long-term plan”.
Regarding the health system’s finances, Colic warned that she did “not have a magic wand to solve all problems in a few days”. The decentralised structure of health care in Bosnia means stark regional differences in available funds, depending on wealth.
Tuzla Canton’s healthcare budget is 45 per cent smaller than Sarajevo Canton’s, where a slightly larger number of healthcare workers provide services for a smaller number of citizens. While doctors, nurses and pharmacists in Tuzla Canton sought an increase of salaries, Colic said she hoped that they “would agree that it would not be fair towards our patients if we spent all the available money on salaries increases”, concluding that, “we will have to find a right balance.”
Tuzla’s health institutions started to collect information on COVID-19 virus already in January. Nijaz Tihić, head of the University Clinic for Microbiology and professor at the medical faculty in Tuzla, noted in an interview already on January 23, that “we should follow this new virus carefully.”
Several days later, in another interview, Tihic announced that Tuzla Canton had increased the monitoring of respiratory diseases. On February 3, Sead Ahmetagic, the 64-year-old head of the University Clinic for Infectious Diseases and professor at the medical faculty in Tuzla, told the media that, “we are closely monitoring all the news and recommendations that the World Health Organisation and the European Centre for Disease Prevention and Control are publishing”, adding that, “in order to prepare for this new virus, which could be potentially dangerous, we will have to reorganise our work and stockpile protective medical equipment for our healthcare workers”.
The first COVID-19 tests were performed in late February. Both Tihic and Ahmetagic would quickly become part of Colic’s closest team in charge of the response to the pandemic.
COVID-19 arrived in Bosnia on March 5, with a truck driver from Italy. In the 15 days that followed, authorities across Bosnia introduced strict measures.
They encouraged social distancing, cancelled all public events, and closed kindergartens, schools and universities. They then closed airports and banned entry to foreigners. Later they went as far as introducing curfews and banning all outdoor activities for everyone under the age of 18 and over 65.
The first two cases in Tuzla Canton, including the nurse, were confirmed on March 27. As the news spread that up to 200 medical workers had potentially been in contact with the nurse, the public started to panic. Colic focused on gaining the public’s confidence.
In her regular morning televised briefing, now wearing her protective mask and gloves, she said that, “from the start of the pandemic we feared one thing the most – that the virus enters our health facilities – and that just happened”. She was honest in admitting that at that time they did “not know when the infection occurred or who patient zero was”.
Colic assured the public that “an enormous effort was made to reorganise the work of the medical facilities in the canton with the aim of protecting all the patients and the staff”, adding that, “we have organised ourselves in several lines of defence and we have enough staff”.
A list with mobile numbers of all epidemiologists was made public, so that citizens could call if they feared they had been in contact with the virus. Colic and her team were also continuously available and communicating via social networks.
In days that followed, news about new confirmed cases in health facilities kept coming. Many feared that Nermin Salkic’s projected spread of the virus, leading to thousands of deaths, was inevitable. But Colic had full trust in her team of 11 epidemiologists, led by Ahmetagic.
When deciding on who gets to be tested, they relied on detailed interviews of suspected cases. In the four weeks after the first case was confirmed, they ordered over 3,000 such tests.
Colic also found a way to cooperate well with the cantonal police, who made sure that the restrictive measures were observed, including the self-isolation of suspected cases at home.
She also relied on an organised network of local activists that encouraged citizens to do what they were expected to. With EU help her team at the ministry made sure the necessary protective equipment such as masks, gloves and suits, was available. The EU also helped them in procuring test kits and related equipment.
In her daily televised briefings, she calmly reported on the numbers of tested and confirmed cases, as well as on the number of people in self-isolation, severe cases and deaths. She rarely complained and never spread panic or false hope.
Judging by social networks, she responded to public criticism and suggestions with concrete actions. Asked about how she dealt with criticism in an interview in 2017, she had answered: “I am self-critical and it is hard for anyone to criticize me more than the one I see in the mirror every day. As long as the criticism is well-intended, I try to take it into account.”
The efforts of Colic, her team and the health institutions of the Tuzla Canton paid off. By April 28, almost 4,000 tests had been conducted. Colic’s team identified eight different clusters in which the virus had spread. In total, so far, there are only 83 confirmed COVID-19 cases in the whole canton. Of those, 78 have already recovered, one remains hospitalised and two are mild cases, on the path to recovery.
Two died. Of the eight identified clusters, six are no longer active since everyone has recovered and in the two remaining active clusters, no new cases have been confirmed since 12 April.
So what happened to Salkić’s projection of 380,000 hospitalised people and 38,000 dead? In his March 27 interview, Salkić had explained that, if “the two-week-long window of opportunity” was used to implement the right measures, then the authorities could “prevent this explosion”.
In that case, Bosnia “would see that the numbers of cases that would be counted would be in hundreds and not hundreds of thousands. Throughout the pandemic, our hospitals would then need to take care of just dozens of hospitalised cases and number of deaths would be low.” When asked if the healthcare systems in Bosnia were doing what was necessary, Salkic said: “I can only speak about the healthcare system in Tuzla Canton because that is where I know the situation well.
Here everything that is necessary was done and that is thanks to readiness of our minister, Dajana Colic, to react early on and be the first to introduce preventive measures.”
When Colic was told that I was working on an article on how the Tuzla Canton has responded to the pandemic, she was not happy.
She said she “was afraid it might jinx what has been achieved so far”. But already, on 8 April, the World Health Organization, WHO, praised Bosnia’s authorities, including her cantonal government, for their “early and prompt reaction and measures”, concluding that compared to other Western Balkan countries, Bosnia “fought the pandemic especially well”. The situation has improved since then.
Like many other Europeans, Bosnians are debating and starting to ease the restrictive measures in the hope of restarting their already weak economy. With no vaccine or treatment available, the health threat from COVID-19 is here to stay. So is the risk that the course of the pandemic takes a quick and negative turn.
The socio-economic consequences of the pandemic are already high in Bosnia. Politicians and citizens assume that less public money will be available, but that demand for state support will be higher. Politicians will have to make tough decisions and implement realistic reforms. They will have to reconcile different interests with scarce resources. But, contrary to a widely accepted cliché, Bosnia has politicians that are able do that successfully. Dajana Colic is one of them.