The prevalence of tobacco consummation in Bosnia and Herzegovina is among highest levels in Europe: 49.3% of adult males and 35.1% of women are current smokers that are every other adult male and every third woman. In order to get a more complete picture of the prevalence of smoking among the health institutions employers and their compliance to the provisions of the law regarding the smoking ban in these institutions, the Institute of Public Health of the Medical Faculty in Sarajevo has conducted a survey on this problem in the area of the Sarajevo Canton. 660 employers of seven health institutions have been surveyed, of which 158 (23.9%) from the Medical Centre of the Sarajevo Canton, 123 (18.6%) from the “Prim. Dr. Abdulah Nakas” General Hospital, 112 (17. 0%) from the Institute for Urgent Medical Help, 85 (12.9%) from the Institute for Public Health of the Sarajevo Canton, 72 (10.9%) from the Institute for the Health Care of Women and Motherhood, 57 (8.6%) from the pharmacies of Sarajevo, and 53 (8.0%) from the Institute for Alcoholism and Substance Abuse. The largest number of smokers is among medical technicians (55.4%), technical staff (56.7%), and administrative staff (51.4%). Approximately 34.0% of medical doctors and specialists and 25.0% of graduate pharmacists are current smokers. The results of the survey indicate the prevalence of smoking among health employers. Law regulations on allowable smoking in special smoking areas are mostly not observed and therefore the largest numbers of employers (approximately three-fourths of them) is exposed to tobacco smoke in their workplaces. A significant number of medical technicians do not identify themselves as models of behavior for their patients. Therefore it is necessary to conduct the education of medical staff on the need to change their own behavior in order to contribute to reducing the number of patients smoking by providing an example, thereby improving their own health status.

The patients’ rights based on ex-Yugoslavian health insurance were very broad: unlimited number of visits and PPZ service, number of diagnostic services, hospital care in the in and outside the country, spa care and climatic treatment centers care, sick-leaves and unlimited number of many other health services. In that period, a great deal of social problems was handled through health care system. There are many examples for this claim, but the doctors that had worked at that time have practical experience (number of sick-leaves caused by an illness of a family member, old and chronic patients’ long stays at hospital etc.) In the period after the war, citizens still had old habits of irrational exploitation of health services, and the legal acts helped them in that. Health Insurance Law and Medical Care Law from 1997 are just modified laws from before the war which kept breadth of patients’ rights. Under the pressure of certain interest associations and groups (Crohn’s disease patients, physically disabled persons – by war and other circumstances, chronic and malignant diseases patients, pressures of financing medical care abroad, etc.) patients’ rights increased regardless of real financial possibilities. Insisting on bringing basic patients’ rights from obligatory insurance over the years succeeded – by the end of 2008 the document went through law procedure and has been acquired. Unfortunately, the document did not create precondition for expense rationalization in medical service, like it was expected, but it was more like the sum of patients’ wishes, except there were no longer people without insurance. A serious question is raised on financial funds that would follow such a broad patients’ rights. Rate of paying from GDP in FBiH takes out 8.82%, which is a good rate of paying compared to the other ex-Yu countries (Croatia 7.5%, Montenegro 6.8%, Slovenia 8.4%, Serbia 8.0%) and EU countries (Sweden 8.9%, Norway 8.7%, Italy 9.0%, Austria 9.9%), and taking in consideration countries from the ex communist block, our rate is higher (Romania 5.7%, Russian Federation 5.3%, Check Republic 6.8%, Bulgaria 6.9%, Albania 6.3%). Unfortunately, statistics brought by simple math does not give us a real insight – all mentioned countries, except Serbia, Albania and Ukraine, have higher GDP than Bosnia and Herzegovina, some of them even seven times higher (Norway), and therefore their annual payment for medical care per capita is several times higher: Check Republic 1940 US$, Italy 2623 US$, Sweden 3119 US$, Slovenia 2065 US$, Croatia 1084 US$. While Bosnia and Herzegovina has substantial GDP rate of paying for health care, on the other hand, annually, it has far smaller financial means per capita (FBiH 431.00 BAM – in 2007, and Sarajevo Canton 619.08 BAM per insured person). Based on 2007 data, a citizen of Sarajevo used medical service in these scopes: 3.7 services in PPZ, 3.29 visits in specialized health care, 1.51 per day, 15.7 diagnostic services, 1.13

In medical practice physicians and other health workers meet patients of inadequate and abnormal behavior on daily basis. That kind of behavior manifests as: Placing unrealistic requests in the sense of their treatment: submitting them disrespectful of the line and order, no charge for the treatment, they create their own medical treatments because they know the best what they need, they set the time-limit-now, they are never content with the quality of prosthetic works, they keep asking for corrections, have unrealistic expectations from the effects of prosthetic works (they want to be able to “bite the wood”, to look younger, etc), they threat that they will send notifications to Ministry of Health Care, media, their speech dominates with sarcasm, cynicism, negativism, obstructive behavior; Very aggressive behavior (anger without any reason, verbal or even physical confrontations with the staff, yelling, spitting, slamming and inventory damaging); Problematic behavior and possible problematic behavior of a number of patients who really have mental health problems (hysterias, PTSP, drug addicts) or they have some kind of psychiatric illness (depressions, schizophrenias). Analyzing examples from practice we came to the conclusion that this kind of patients’ behavior is caused by several elements: a number of patients has the need for social contacts because they are lonely in everyday life: retired people (especially the ones with no family), housewives whose family members have no time for their “troubles”, most of the time they come to the place where they must be talked and listened to – medical service center. Some patients think that they have the right to anything even the things that are nonexistent in nomenclature of medical services just because they are medically insured and they own health record; they are especially furious because of the participation in costs of prosthetic works (“the staff takes that for themselves”), they constantly look for flaws in done works and they come for unnecessary corrections many times. Aggression in communication are demonstrated by: alcohol intoxicated persons, drug addicts, “difficult persons” who consider arguments and insulting a normal way of communication, persons who consider themselves very important on social hierarchy (you don’t know who I am, who is my husband etc), persons who consider that injustice is constantly brought on them, persons who are psychiatric patients and are not taking prescribed therapy, so one never knows when they are in their “bad” phase. This kind of behavior of patients has negative effect on two accounts: on other patients who are in the waiting room and often spend much more time there they should which makes them anxious and also creates negative attitudes and reactions because of the problems that the medical staff has with problematic patients. Medical staff is constantly under pressure which inevitably leads to stress, and they are often in situation that they a

Public health in B&H has long tradition. In this article authors presented development of public health in Sarajevo and Bosnia and Herzegovina.

The family medicine as the determination of the reformators and the strategies of the action in BiH is given in the form of the legal solution in the organization of the primary healhtcare action in BiH given in the form of the legal solution in the organization of the primary healthcare protection (the law about the healthcare protection--official newspaper F/BiH No 29/97). The fact is given the alternative solution--the team of the family medicine or the team of the medicine. Besides this there exist also some essential questions about the registration of the patients for the family medicine teams make complex the forming of the next of the family medicine. Besides that there are also some essential questional about the registration of the patients for family medicine teams--whethers that they registrar all the citizens or only the insureds to which is insured the healthcare protection though the medicine--werther are being registered all the citizens, whom belong the active ensured whom is ensured the healthcare protection through the institutions for the work medicine, the students and sportsmen who also have their institution etc. The further problem, when is in questions the patients registration of the patients, is the nonexistence of the reliable statistical data about the number, sexual inhabitants, as is known all the estimates are being done on the basis of the estimation of the federal institution for statistics. Therefore the registration of the family and the individuals for the family medicine teams will be rather painstaking.

Health workers are exposed to the accidental injuries with blood, so that increasing of HBsAg among inhabitants in Bosnia and Herzegovina and professional risk for VHB is increased in this risk group. Among 6.712 health workers in Canton Sarajevo, it's expected that 1.217 health workers will be exposed to the professional accidental injury with the blood, but it's expected annually 44 professionally infected health workers with HBV. With introduction of vaccine against HBV it would come to very important decreasing of the diseases among health workers (p < 0.001), but the risk for the disease HBV would decrease 45 times.

It is known that the significance influence the numerous factors and that their knowledge and the recognition of the mutual connection and action of the necessary precondition for every organized activity. In the up to now practice the organization of the healthcare protection and healthcare politics often discourage the partner and inter-sectorial approach to the pre-motion of the health. The education of the studying about the significant factors in the promotion of health. The good manner to provoke the interest for the values of health and its maintenance is to insure the place in the educational programmes through the educational system in schools. The work of the teachers should be to include the pedagogic methods and the own behaviors which to the children will help to develop the ability of the making of the correct decisions of the way of life. The aim of papers is to illustrate the model of the introducing and the advancement of the inter-sectorial collaboration in the promotion of health, through the experience of the institution for the public healthcare in the paper at the prevention of the narco-many in school children and youth of Canton Sarajevo.

The dialysis setting as a height risk environment for transmission to both patients and health care personnel of blood-born infections, such as hepatitis B virus and hepatitis C virus We report the results of questionnaries of the frequency of occupational exposure in dialysis units. Among 120 health care workers of dialysis units had 25.02% percutaneous injure or mucous. Introducing of oxidative new virucid dezinficients prevent high risks of spreading of viral hepatitis in dialysis units.

The disease of the dependancy in Bosnia and Herzegovina in the postwar period are in the expansion, and the fact is that nobody of the competents can expose the correct data about the extension of this occurrence. The reason to this is that in the health care institutions are evident only those dependents who attend to treatment, and the police evident only the catched breachers of law--the producers and the dispersals of the drug. The periodical researches which are performed among the different population groups do not give unfortunately, also besides the setted endeavour, the right insight into this problematics. Besides the fact that the production and distribution of tobacco and alcohol are legal, cannot be neglected their lost effect onto the health by the excessive and longterm consummation, so to them as the psycoactive substances should dedicate the adequative attention. The treatment consequence of the disease dependance is longterm and expansive, often with uncertain outcome, especially in narcomen the dependence (the percentage of the recovery from 0.5-4.0%), so the basis of the struggle against the dependancy disease is the prevention affirmation of the healthy styles of living--without tobacco, alcohol and drugs. Many theoretics, the authors of the scientific papers from these field prevention share to three levels--the primary, secondary and tertial ones, but the public-health care approach only the primary three levels the primary prevention considers the right prevention which is the dam of the disease occurrence and the damage, the rest two levels infact are the diagnostics, treatment and the rehabilitation and not the aim is to them the reduce of damage, so much and if is this is possible. Of course, should not neglect the great difference in costs in the levels of the prevention: the methadone therapy and the commune for the treatment and the rehabilitation of the dependents encircle the small number of the dependence and cost hundred times more than the primary preventive programmes, which address to the unavoidableness of the performance of the strategy of the primary preventions against the disease of the dependancy.

In the period from 1945 till 1992 the health protection had constant growth of coverage, availability and quality of protection in the promotion of health care of the inhabitants, and the health care activity noticed spreading of the network of health care institutions, evidently staff improving of all profiles of health care workers, and supplying of equipment so said in the accordance with the movements in for developed countries. The detaching for health care in 1990 amounted 6.9 per cent of that time BDP. The period from 1991 till 1955 is difficulty to analyze, because of the disturbances which appear in all sphere of life and work, and the period from 1996 till 1999 can be analyzed, from the already known reasons, only for the area of the Federation. The correct amount of the means of payment spent for health care in the postwar period is impossible incorrectly to confirm, except detaching from BDP (1999 3.7 per cent) arrived the donations in equipment, drugs, sanitary material, training of staff, free of charge experts, means for the reconstruction of objects, to this in the future cannot be considered. Besides that the rate of detaching for the health care from BDP is less than before the war, BDP by it self is far lesser what means that the means of payment detached are far lesser. It is necessary the URGENT reform of health care financing system, evaluation strategy of the reform of health care which up-to-now did not show shifts, the bringing of instruments of planning in the health care, instruments of quality control, the legislator must define clearly the relations between the private practice, patients and state funds.