Application of the RC service model of HBC into the social and health system of Bosnia and Herzegovina (achievements and challenges)

Abstract

Introduction: Bosnia and Herzegovina is country with population of 3,531.159 and 14% of total population is over 65 years. In BiH there are no policies to respond to demographic change and its consequences especially to the category of elderly population. Traditionally, the role of the family institute in caring for its aged has been very strong in Bosnia and Herzegovina, but has been diminishing rapidly. The social situation, status of elderly is further aggravated by the late payment of pensions, increase in prices of food and medicine. Health and social protection is characterized by fragmented funding, uneven and often unequal provision of services and unequal access to assistance. The needs for care of sick elderly who live at home remain unmet. State health centres are obliged to provide medical care at home. Their service is time limited and do not include home care services for elderly people with chronic and long term conditions who need regular support to stay at home. As a respond to these growing needs the Swiss Red Cross (SRC) supported the local Red Cross (RC) to build up a new model of Home Care in Tuzla Canton. Description: In order to know the needs in primary care at community level a baseline assessment on 219 respondents aged 60-90 was conducted. Based on those results in two pilot areas - one urban with 150’000 and one rural with 46’000 inhabitants - a model of providing social and medical care at home was built up. The “Home Care” model has four pillars of care provision: Medical care provided by professional nurses; Individual care (personal hygiene of semi-mobile and immobile clients, etc.) and household services (laundry washing, cleaning etc.) provided by trained auxiliary nurses; Social services provided by younger and older volunteers trained in psycho-social support. The RC Home Care model allows elderly people to remain much longer in their habitual environment with the best care possible. Legislative regulations, payment mechanisms, quality standards for social and medical care at home provided by non-governmental organisations do not exist. To lobby and promote them a multi-actor and cross-sector working group was started in 2016. This working group has already achieved an important milestone when the authorities agreed to co-finance the services. Conclusion: After almost four years of hard work, first results are visible. In 2014 Red Cross HBC Centres started to provide services for 14 clients by one nurse and two auxiliary nurses, while in 2016 nursing staff (2 nurses and 14 auxiliary nurses) and 36 volunteers provided services for 260 clients (over 18.000 hours). The most requested services were individual care. Progress in care is evident. Clients are more independent and their mobility is increased. However, there is no unique solution to the increased demand of home care due to the social and demographic changes in Bosnia and Herzegovina. The following issues were crucial to build up the model: need for home care services and type of service confirmed by in depth assessments; services need to be demand driven; existing legal framework is an important factor for economical sustainability; nurse-led services requires a shift of paradigm and change in the legislative framework. This requires evidence based advocacy to withstand a strong lobby; well trained home care staff and their continuous education.