Update No. 97/01 on ICRC activities in the former Yugoslavia
02-06-1997 Operational Update
Health situation in Bosnia and Herzegovina
There has been little progress within the health systems of Republika Srpska (RS) and the Federation of Bosnia and Herzegovina (FBiH), and in some areas the situation has even deteriorated since the end of open conflict. Both Ministries of Health are facing the double burden of rebuilding structures damaged by the war and upgrading them to meet modern standards. New health laws have yet to be passed in both entities to enable a newly organized, more cost-efficient health system to be set up.
Scarcity of funds affects the health care system
The FBiH and RS Ministries of Health lack financial resources. For example, by 1995 per capita health spending in the FBiH had decreased to US $ 5 from US $ 150 before the war. World Bank aid and grant money from the international community is earmarked for reconstruction and cannot therefore be spent on running costs of health-care facilities. Before the war, health care was covered 100 per cent by the social system. Now the health system is funded through health insurance schemes. Owing to an unemployment rate of 80 per cent, these resources are not even enough to pay small irregular salaries to the medical staff.
Dependence on humanitarian supplies
Before the war, the Socialist Federal Republic of Yugoslavia was producing more than 80 per cent of its pharmaceuticals in 16 specialized enterprises; in 1995 the pharmaceutical industry in Bosnia and Herzegovina provided only 8 per cent of the required drugs. Both FBiH and RS remain very dependent on humanitarian aid as they do not have the means to purchase medicines and materials. Humanitarian organizations provide 50 per cent of the total drug requirements in the RS while the FBiH is almost totally dependent on foreign aid. In the RS the ICRC has started to evaluate the situation of medical centres and humanitarian pharmacies (pharmacies supplied by humanitarian organizations, which were set up during the war to provide vulnerable groups with medicines free of charge and which are now used by all population groups) in order to assess the effect of the ICRC ending supplies. First results have already shown severe shortages in certain areas: in some facilities, up to 60 per cent of prescriptions are unable to be filled. More and more people are encountering problems due to the lack of specific medicines and the return of refugees will further increase the demand for these products.
ICRC support programmes
In 1992 the ICRC began providing regular monthly supplies of surgical material to all medical facilities in Bosnia and Herzegovina; currently 31 facilities are still receiving this support. In addition, in 1994 an " ECD programme " (essential drugs for chronic diseases) was launched in the RS and other places where such needs had been identified. Following the signing of the Peace Agreement in late 1995, the ICRC reduced both programmes with a view to discontinuing them after the end of 1996. However, in view of the many pressing requests it received from hospitals and health authorities, and based on its own assessments, the ICRC decided to extend its medical assistance into 1997.
In the Republika Srpska , the ICRC provided a three-month ECD drug supply to domovi zdravlja (health centres) and humanitarian pharmacies in December 1996. The situation of these facilities was then closely monitored during the first quarter of 1997 to see whether it would be possible to end supplies. In eastern Bosnia, where other organizations are working, the ICRC will discontinue regular supplies. However, severe shortages and the absence of organizations providing assistance in the Banja Luka region mean that the ICRC will extend its programmes beyond October 1997, the original date of completion planned in its 1997 Emergency Appeals. Distributions will continue at least until the end of 1997, and probably through to next year.
In the Federation of Bosnia and Herzegovina, the ICRC regularly receives requests from the cantons for basic supplies for domovi zdravlja and ambulantas (health posts). To help meet these needs and support the cantonal health authorities, the ICRC plans to carry out a delivery of basic medicines and dressing materials to those cantons which have the infrastructure to dispatch them to the medical facilities.