key: cord-0733761-boraj081 authors: Cilovic-Lagarija, Seila; Hasanica, Nino; Mulic, Maida; Radojicic, Milan; Brankovic, Suada; Pilav, Aida; Huseinagic, Senad; Musa, Sanjin title: An Overview of Human Resources and Capacity in Health Care Institutions in the Federation of Bosnia and Herzegovina in the Context of Responding to the COVID 19 Pandemic date: 2021-03-03 journal: Mater Sociomed DOI: 10.5455/msm.2021.33.56-59 sha: 1c531fcc1e5ea630cca557fdb7520c842dc0d217 doc_id: 733761 cord_uid: boraj081 BACKGROUND: The organization of health care system on Cantonal level with the coordination from Federal level represents a real situation with the possibility of decentralization of health care system according to the experiences of developed countries. OBJECTIVE. To make an overview of the situation at the primary and hospital health care level with the aim of assessing the existing human resources and capacity of health care institutions in FB&H, with which we entered in COVID-19 pandemic. METHODS. This retrospective study presents the efficiency of health care in FB&H measured by number of medical doctors, and other medical staff during the time period of five years. Data of the Institute for Public Health FB&H were used. The Institute for Public Health FB&H is authorised by the law to conduct and implement statistical research in the field of health care in line with relevant laws and by-laws. The Institute is obliged to report on organisational structure, human resources and medical equipment. RESULTS. Presented data include the number of health care employees in medical institutions in FB&H in the period 2015-2019 per 100,000 inhabitants and their numbers in primary health care, family medicine, secondary and tertiary level of health care in 2019. The study also presents the number of doctors of medicine, specialists and medical residents in FB&H, the number of nurses of all profiles and levels of education as well as medical staff and other employees in the public health care system in FB&H in 2019. CONCLUSIONS. The COVID-19 pandemic in FB&H has confirmed the fact that human resources in health care are insufficient, especially in the field of public health and epidemiology. The availability of these health facilities and human resource is not uniform throughout the FB&H, which may affect the capacity of the health system in some parts of the FB&H to meet the needs of providing services during COVID-19 pandemic. The goal of health care is the promotion, improvement of health, prevention of diseases, detection of diseases, effective treatment, and rehabilitation (1). The aim of this study is to make an overview of the situation at the primary and hospital health care level and to assess the existing human resources in health care institutions in FB&H with which we entered in COVID-19 pandemic. The organisational structure in FB&H is as follows: at the pri- Year Doctor of Medicine Doctors of Medicine in those services, over two-fifths (808) had completed specialisation in family medicine (Table 3) . (Table 4 ) (4, 9) . Specialist and consultative health care during the COVID-19 pandemic. Some branches of specialist and consultative health care, as well as the data on available medical staff during the CO-VID-19 pandemic are presented in Table 5 . According to the latest (62.94%) of them being in the age group over 55 years of age (4, 9) . Number of hospital beds. The number of hospital beds for 2019 is 7,315, while the number of intensive care beds in all hospitals is 523. The rate of hospital beds is 329.6 per 100,000 inhabitants (4). diseases with a total of 180 beds (4). This epidemic is a great challenge for the health care system and the authorities in terms of timely response with efficient and adequate interventions, policies and recommendations. Since 16 March 2020, when the state of natural disaster was proclaimed, the main response against the COVID-19 pandemic has been provided by medical staff along with citizens who have complied with restrictive measures. A breakdown of the number of medical staff, available capacities in health care institutions, organisational structure in the health care system is a basis for an analysis of the health care system of a country (4, 9) . In the European Union (EU) the highest rate of doctors of medicine per 100,000 inhabitants is found in Greece with 625, which is followed by Austria with 515, Portugal 443 and Norway 442, while the average in EU is 343 doctors of medicine per 100,000 inhabitants (11, 12) . The rate of Doctor of Medicine in FB&H in 2019 was 232/100,000 inhabitants. According to the latest available data of the World Health Specialization 2015 2016 2017 2018 2019 M F M F M F M F M F Anaesthesiology with reanimathology 56 112 55 112 55 122 59 127 52 117 Infectology 13 39 11 42 11 38 13 38 12 37 Internal medicine 141 171 131 170 136 168 136 161 120 150 Pneumophthisiology 38 61 35 60 35 61 33 64 40 57 Radiology 59 88 57 87 66 91 61 101 50 81 Emergency medicine 57 55 58 60 61 62 59 65 59 (13) . Health workforce imbalances and shortages are a major concern in the European Region. The number of physicians and nurses has increased by approximately 10% over the past 10 years. Still, it is unlikely that this increase will be stable and sufficient to cover the needs. There are five times more doctors of medicine in some countries than in others. Some countries have nine times fewer nurses than others (14) (15) (16) . A norm for public health care at the primary level of health care, i.e. hygiene and epidemiological services includes one working team per 40,000 inhabitants (10). One team comprises one doctor of medicine specialised in epidemiology, one bachelor of sanitary engineering with completed first cycle of higher education (or the 6th grade of higher education according to domestic law), and two nurses or sanitary technicians with secondary school education. If an area for which these services are provided requires three or more teams, then one team can have a specialist in hygiene and health ecology (17) (18) (19) (20) (21) . According to this staffing norm, hygiene and epidemiology services in the territory of FB&H need 55 Doctors of Medicine specialised in epidemiology, which indicates a lack of this profile, that is, in addition, inadequately distributed geographically. Proper management of human resources is critical in providing a high quality of health care. Effective human resources management strategies are greatly needed to achieve better health care outcomes (21) (22) (23) (24) . The COVID-19 pandemic in FB&H has confirmed the fact that human resources in the field of health care are insufficient, particularly in the field of public health, primarily doctors of medicine specialised in epidemiology, but also doctors of medicine with other specialities (25, 26). It needs to be pointed out that a large part of duties was taken over and carried out by medical staff of other educational profiles. In a situation of mass spread of infectious diseases (especially in pandemic form), the ability of outpatient health facilities to take part of the pressure to solve the health problems of patients is extremely important. Where there is well-developed primary health care, trained to act in a pandemic, enormous pressure on hospitals can be prevented. The leaders in the healthcare system are, of course, healthcare professionals. The number of health workers, who are currently leading the main fight in the COVID-19 pandemic, must be institutionally and systematically planned. • Author's contribution: All authors were involved in preparation of this article. Final proofreading was made by the first author. • Conflict of interest: None to declare. • Financial support and sponsorship: No specific funding was received for this study. Social Medicine and Organization of Health Protection 1. Medical Faculty in Sarajevo Federal office of statistic. Statistical Yearbook Efficiency of dental health care in Federation of Bosnia and Herzegovina Institute for Public Health of FBH. Health statistics annual of Federation of Bosnia and Herzegovina Law on Health Records, Official Gazette of FB&H Ordinance on the form and content of basic medical documentation, Official Gazette of FB&H Ordinance on the form, content and manner of keeping individual reporting forms and other auxiliary forms for keeping records, Official Gazette of FB&H Ordinance on the manner and deadlines for submission and form of summary reporting forms, Official Gazette of FB&H Institute for Public Health of FB&H. Health status of the population and health care in FB&H Order on amendments to the Order on standards and norms of health care from compulsory health insurance, Official Gazette of FB&H The importance of human resources management in health care: a global context Public Health Aspects of Global Population Health and Wellbeing in the 21st Century Regarding Determinants of Health Determinants of Health and Health Concepts Acording to WHO Targets Javnozdravstveni aspekti porodicne/obiteljske medicine u Bosni i Hercegovini Procjena kvaliteta u primarnoj zdravstvenoj zastiti Kriteriji za izbor adekvatne metodologije i relevantnih varijabli za procjenu kvaliteta primarne zdravstvene zastite [Criteria how to choose adequate methodology and relevant variables for assessment of quality of primary healthcare Procjena broja potencijalnih korisnika usluga porodicne medicine--vaznost registracije korisnika [Determination of the potential number of users of family medicine services--importance of user registration Edukacija iz obiteljske medicine na Medicinskom fakultetu u Sarajevu Porodicna medicina -Principi I Praksa/Family medicine -Principles and Praxis Healthcare personnel statistics -nursing and caring professionals World Health Organization. Regional Office for Europe. Health workforce data and statistics