1. BOSNIA & HERZEGOVINA KEY FACTS
Brief overview on health sector with estimated impact of HANS
Semra Čavaljuga, MD, MSc, DSc
Ancona 29 July 2008

2. BOSNIA & HERZEGOVINA KEY FACTS

3. BOSNIA & HERZEGOVINA KEY FACTS

4. BH GENERAL ECONOMIC INDICATORS

5. NOMINAL GDP, BILLION EUR
REAL GDP GROWTH RATE, %
GDP is continuing fast growth in 2007 with nominal rate of 11.8% and real growth rate of 8%. For the first time GDP per capita exceeded amount of 3,000 EUR and is continuing to approach GDP per capita of less developed EU member states (Bulgaria and Romania). We are assured that BiH will keep that growing trend in the current year and maintain its leading position among neighbouring countries regarding the level of real GDP growth rate.

6. INDUSTRIAL PRODUCTION GROWTH RATE, %
Since 1999 average annual growth rate of industrial production was 8.5% and in 2007 reached growth rate of 10%. Previously announced new investments, especially in metal processing and wood industry, confirm optimism regarding further industrial production growth.

7. ANNUAL INFLATION RATE, %
Inflation in 2006, mainly caused by VAT introduction, was reduced to 4.9% in 2007 which is equal to the estimation for CEE countries. It is expected that inflation rate in the next period will be at the same level as before introduction of VAT.

8. ANNUAL UNEMPLOYMENT RATE, %

9. Unemployment, which is one of the most serious problems of domestic economy, slowly declined in 2007 (according to official records, number of registered unemployed persons in 2007 was reduced for 2.7%). Even though capital inflow during the first stage of privatization process caused decrease in the number of workplaces, it can be stated that FDI made a positive impact on the decrease unemployment rate. The largest contribution to the decrease of the unemployment was made by Greenfield investment (establishment of new companies), which in the year 2007 participate with 40% in the total FDI. Labour Force Survey gives more realistic picture about labour market in BiH. Result of the survey is unemployment rate of 29%. The World Bank statistics show the real unemployment rate in BiH, which is around 16%.

10. CURRENCY RESERVES, MILLION EUR
Currency reserves record permanent growth and at the end of 2007 they were 3,420 million EUR, which is 18.5% more then in the previous year.

11. FOREIGN DIRECT INVESTMENT IN BIH
TOP INVESTOR COUNTRIES IN BIH ( )
Since May 1994 to December 2007, the most investment was made by companies from Austria 27.9 %, Serbia 16.7%, Croatia 11.8%, Slovenia 9.2%, Switzerland 7.3%, Germany 5.8%, Netherlands 2.4%, Italy 2.2%, USA 1.7%, Turkey 1.4%, and other countries 13.6%.

12. According to the FDI inflow year 2007 is a record year
According to the FDI inflow year 2007 is a record year. Foreign direct inflow in 2007 was 1.62 billion EUR and was tripled comparing with Investment in 2007 is 36% of total FDI recorded since May Greenfield investments participate with 40% in total FDI in FDI contribution in GDP in last year was 14% and it proves that BiH economy is significantly improving investment climate and that it became attractive location for investment.

13. EXTERNAL TRADE IN 2007

14. Foreign trade deficit is not unusual for the countries in transition, even though it achieved 40-50% of GDP. BiH foreign trade deficit in 2006 was reduced to 34.8% of GDP and its further decrease is expected. Export coverage in 2006 was 44.1%, the biggest so far, and kept the same level in It’s very important to emphasise that the following goods dominate BiH’s import: basic metals, coke, petroleum products, machine, devices and equipment, chemicals, rubber and plastics, vehicles, and represent 60% of total import, with amount over 4 billion EUR. Those data show that trade deficit is mostly caused by goods needed for manufacturing and investment activities, proving the fact BiH is generating investment.

15. BiH Health sector: facts
Bosnia and Herzegovina comprises two entities: the Federation of Bosnia and Herzegovina (Federacija Bosna i Hercegovina) and the Republika Srpska, as well as the independently administered District of Brcko – over which neither Republika Srpska nor the Federation of Bosnia and Herzegovina have jurisdiction. Each of the above-mentioned two entities cover about km2 of land.

16. BiH Health sector: facts
There is NO health mininistry in CoM (Council of Ministeres), but health sector is part of Ministry of Civil Affairs – some coordinative functions
The governments of the Federation of Bosnia and Herzegovina and Republika Srpska are charged with overseeing internal functions; this includes all activities related to health.
The ten Federation of Bosnia and Herzegovina cantons share responsibility with the Federation government for health, natural resources and environment, social welfare, education, tourism, and other public services.

17. BiH Health sector: facts
Demography and health
All population-based data in Bosnia and Herzegovina are estimates, since an official census of the population has not yet been undertaken since the war ended.
 The war had a strong impact on the demographic and health situation (According to 1998 estimates and compared with the 1991 census, the population is believed to have decreased by more than 16%...). nn

18. BiH Health sector: facts

19. BiH Health sector: Facts
According to the Dayton Agreement, which broke down the country’s health system into two separate systems, health care organization, finance, and delivery would be the sole responsibility of each entity. After the signing of the Agreement, the entities approved their separate health legislations as health laws. Created in 2000, Brcko District, with an estimated population of , has its own obligation to organize, finance and deliver health care services – as expressed in the Law on Health Care of the Brcko District of Bosnia and Herzegovina.

20. BiH Health sector: Facts
Health care finance, management, organization and provision in Bosnia and Herzegovina are the responsibility of each entity, while Brcko District runs a health care system over which neither entity has authority. Bosnia and Herzegovina, therefore, has 13 ministries of health and health systems for its 3.8–4.3 million population (see above): one for Republika Srpska, one for Brčko District, one for the Federation level and ten cantonal ministries in the Federation of Bosnia and Herzegovina (one for each canton). In brief, the different organizational structures of each entity plus Brčko District are as follows:

21. BiH Health sector: Facts
In Republika Srpska, authority over the health system is centralized, with planning, regulation and management functions held by the Ministry of Health and Social Welfare in Banja Luka.

22. BiH Health sector: Facts
In the Federation of Bosnia and Herzegovina, health system administration is decentralized, with each of the ten cantonal administrations having responsibility for the provision of primary and secondary health care through its own ministry. The central Ministry of Health of the Federation of Bosnia and Herzegovina, located in Sarajevo, coordinates cantonal health administrations at the Federation level. This feature will have obvious functional repercussions in terms of transaction costs, coordination of decision-making at the entity level, and other matters not faced by Republika Srpska.

23. BiH Health sector: Facts
The district of Brčko provides primary and secondary care to its citizens. Because of the small size of its population, the above-mentioned Agreement on Brčko (Agreement on the implementation of the entity obligations from the final arbitral award for Brcko on health care and health insurance. Sarajevo, OHR, 1999.)
It is essential to understand that there is no national mandate for health care financing and provision.

24. Organizational structure of the health care system in the Federation of Bosnia and Herzegovina

25. Organizational structure of the health care system in Republika Srpska

26. Collection of data for HANS:
3 agencies for statistics:
BHAS – BiH Agency for Statistics
Republic of Srpska Institute of Statistics
BiH Federation of Bosnia and Herzegovina Federal Office of Statistics
Other sources:
FBiH Institute of Public Health – Annual Reports
Cantonal Monthly and Annual Reports

27. Collection of data for HANS:
National Cancer Register
NO Cancer Register for FBiH (Yes for RS, but data not available),
As no census, denominators are estimated

28. HANS impact: Regional action on data collection Common indicators
Raise awareness on common approach for data collection
BUT:
Political agreement condicio sine qua non

29. ????

30. Thank you!