: This report outlines a strategic approach to introduce pay-for-performance (P4P) incentives for improved noncommunicable disease (NCD) care in Republika Srpska (RS) and the Federation of Bosnia and Herzegovina (FBiH). Developed under the Health Systems Improvement Project (HSIP) and Multi-Donor Trust Fund (MDTF) for Health Systems Reform, the approach focuses on evidence-based, technically sound, and politically feasible strategies. Participatorily developed, the report synthesizes global lessons and analyzes the policy environment in RS and FBiH. It proposes key design features, addressing strategic opportunities and operational challenges. Behavioral economics insights and political economy factors inform the approach, identifying key levers, opportunities, and challenges affecting P4P implementation capacity. To enhance NCD care quality, the report recommends changes in the provider payment mix, tailored reforms at entity and cantonal levels, and active service user engagement. Emphasizing the importance of linking payment incentives to performance, the proposed design spans dimensions such as performance measures, basis of payment, payment attributes, recipient of payment, and targeted outcomes. An enabling environment is deemed critical. Relatedly, effective implementation requires robust data systems, stakeholder engagement, adapted legal frameworks, and suitable institutional arrangements. Technical assistance and budgetary support needs are identified. It is expected that P4P implementation will enhance NCD care coverage and quality, thereby improving health outcomes and overall health system performance in RS and FBiH.

Human coronaviruses are agent which cause respiratory illnesses and have been described to be continously emerging. Seroprevalence of IgM/IgG antibodies was determined by lateral flow immunoassay. Study were include data on participants experience of COVID-19 symptoms during the pandemic (including symptoms and health status). Among 443 serum samples for detection seroprevalence, 186 (42.0%) were seropositive on specific antibodies (IgM/IgG) or participants who had COVID-19 with or without symptoms. Of the seropositive the age group 25-50 years old had the highest percentage (32.8%) followed by 51-64 years (30.6%). Ninety seropositive patients (out of 186; 48.4%) were detected with the specific symptoms. The most frequently symptoms were fever (n=54, out of 90; 60.0%), muscle pain (46.7%), dry cough and loss of smell (36.7%) and others. More than one symptoms were detected in 59 cases (65.6%). The most common comorbidities were diabetes mellitus (n=12, out of 186; 6.5%), than hypertension (nine; 4.8%) and heart diseases (seven; 3.8%). More than half of seropositive were asymptomatic (n=96, out of 186; 51.6%). Note: In period March 2020 - June 2021, among 3323 samples, 804 (24.2%) were positive on SARS-CoV-19 with RT-PCR. The results showed that 394 (out of 804; 49.0%) positive samples were collected from female and 410 (51.0%) from male. The most prevalent of SARS-CoV-19 viruses were detected in > 65 years old (n=267, out of 804; 33.2%). Further research on the contribution of symptomatic or asymptomatic individuals to the community spread of COVID-19 is essential for effective control of the pandemic spread of SARS-CoV-2.

Objectives: Improved serological detection of specific antibodies against SARS-CoV-2 could help estimate the true number of infections. Methods: A total of 443 serum samples provided by unvaccinated patients of all ages with unknown COVID-19 status that were originally submitted for routine screening or clinical management from outpatient laboratory during the March–April 2021 (third wave) were collected. Seroprevalence of IgM/IgG antibodies was determined by lateral flow immunoassay (Tigsun, Beijing, China). Results: Among 443 serum samples, 186 (42.0%) were positive (incidence of 5.2/1000) with slight predominace of females, 104 (55.9%), highest seropositivity in 25–50 and 51–64 years age groups, 61 (32.8%) and 57 (30.6%), respectively (P < 0.05); rural population was more prevalent, 101 (54.3%) (P < 0.05) and active workers, 86 (41.1%). Almost equal number of patients was with or without symptoms, 48.4% and 51.6%, respectively. For the comparison, in the same period it was registered 296 (out of 855; 34.6%) PCR SARS-CoV-19 positive persons (incidence of 8.2/1000) with the higher gender (females) and the highest age prevalence in 51–64 years age group (36.8%). In the period March 2020–June 2021, it was registered 804 (out of 3323; 24.2%) (incidence of 22.3/1000) PCR SARS-CoV-19 positive persons with no significant gender and significant age difference (25–50 and 51–64 years group, respectively). Conclusion: In the regions with high prevalence/incidence of SARS-CoV-2 in the general population (Bosnia and Herzegovina is on the World top on the number of deaths) seroprevalence measuring can help tracking the spread of disease.

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.

Aim To assess prevention and reduction of trismus after surgically extracted impacted mandibular third molars with individual and combined therapy with corticosteroids and anti-inflammatory analgesics. Methods The research included 60 randomly selected patients (3 groups) attended to the Dental Oral Surgery of the Public Institution Healthcare Center Zenica during the period January-December 2008. Patients of both genders, 18-45 years of age, were presented without pain and other inflammatory symptoms at the time of surgery. According to a scheme established in the research protocol, two medications were administered orally: methylprednisolone(corticosteroid) 32 mg and meloxicam (non-steroidal anti-inflammatory analgesic, NSAID) 15 mg as a single drug, or a combination of both drugs. The level of trismus is assessed on the basis of differences of preoperative and postoperative values of interincisal spaces when fully opening the mouth on the second and the seventh post-operative day. The differences between groups of patients were evaluated by means of Tukey's HSD test. Results On the second and on the seventh post-operative day significantly better results were registered in the group that received only corticosteroids and in the group that received both, corticosteroids and NSAIDs compared to the group that received only NSAIDs. A tendency of trismus reduction was present in all patient groups for the second and seventh day after surgery. Conclusion Prevention and control of postoperative trismus after surgical extraction of impacted mandibular third molars with combined therapy is effective and superior comparing to individual therapy with meloxicam-or methylprednisolone alone.

Aim. To determine the influence of sociodemographic factors on patients´ satisfaction with health care system. Methods. In a cross-sectional study, 1,995 patients from 12 municipalities of Zenica-Doboj Canton were interviewed after a visit to the practice. Individual interviews were conducted and the questionnaire was made on the basis of EUROPEP (European Task Force on Patient Evaluations of General Practice Care) standardized questionnaire. Results: Out of the total number patients, 47.1% were females, 47.9% were from urban population and median of age was 42.0 years (IQR = 30.0 to 53.0 years). The rural population was more likely to buy drugs for medical treatment (p < 0.001) and parenteral injections in primary care practice (p < 0.001). Patients with lower level of education were more likely: to be ordered for physical examination (p = 0.001), to buy drugs for medical treatment (p = 0.001), to buy parenteral injections in primary care practice (p < 0.001); to pay unofficially to someone from medical staff (p < 0.001); to feel that they could be better treated (p = 0.032) and they had longer waiting for health service in primary care practice (p < 0.001). Older population had better assessment of secondary (p = 0.040) and tertiary health care practices (p = 0.034); needed more time is needed to reach health facilities (p = 0.016), longer waiting for health service in primary care practice (p < 0.001); more likely to have health problems in the past 12 months but they did not request medical treatment (p = 0.008); more likely to be ordered for physical examination (p < 0.001); more likely to buy drugs for medical treatment (p = 0.004); more likely to buy parenteral injections in primary care practice (p < 0.001). Conclusion: The following variables: gender, age, overall perception of health status and financial status appear to be predictors of patients´ satisfaction.

Aim: The aim of this study is to evaluate the effects of „pay for performance“ (P4P) preventive-promotive program within family medicine teams in Bosnia and Herzegovina being reimbursed by bonus payment. Material and methods: The tested model of bonus payment improved provider performance in the intended fashion. Experimental group of teams, being reimbursed by bonus payment, demonstrated significantly higher performance in comparison to control group, being reimbursed by flat rate payment just for proper reporting. Bonus payment encompasses threshold and range for each service being evaluated, as well as ponders for five indicators of performance. Results: The project has developed a standardized approach to preventive and promotive services within family medicine as added value to P4P program, what resulted by improved governance within health care system. Although there are higher values of females being checked-up in the beginning of the program, as well as elderly, this concept is not considered as one to impair equity on the long run. Also there is no tendency to ‘good risk selection phenomena’.