#1Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H Bosnia and Herzegovina country presentation Ahmed Novo MD, Ph.D Agency for Healthcare Quality and Accredition in Federation of Bosnia and Herzegovina (AKAZ)#2G Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H Presentation overview • Maternal and neonatal healthcare in Federation of Bosnia and Herzegovina; ●Main achievements in assuring quality of maternal and neonatal healthcare; Main challenges and lessons learned; Existing quality assurance mechanisms and their effectiveness; •Expected ways forward. 2#3Q Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H 3 Bosnia and Herzegovina Republika Srpska Federation of Bosnia and Herzegovina Republika Srpska л Area - Total 51,197 km² Population - 2014 census 3,871,643 GDP (PPP) 2014 estimate - Per capita $ 4,655 (World Bank)#4G Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H Federation of Bosnia and Herzegovina 4 10 8 4 Area - Total 26,110 km² Population - 2014 census 2,371,603 No. Canton Center No. Canton Center 1 Una-Sana Bihać 6 Central Bosnia Travnik 2 Posavina 3 Tuzla Orašje Tuzla 8 West Herzegovina 7 Herzegovina-Neretva Mostar Široki Brijeg 4 Zenica-Doboj Zenica 9 Sarajevo Sarajevo 5 Bosnian Podrinje Goražde 10 Canton 10 Livno#5G Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H 5 Overall context of maternal and neonatal healthcare in FBiH (1) 18 maternal wards; Health personnel with university degree by specialization ●210 gynecologists; ●245 pediatricians. Nurses 847 obstetric nurses; 436 pediatric nurses. Health Statistical Annual FBiH 2012, Institute of Public Health of Federation Bosnia and Herzegovina (2013)#6G Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H Overall context of maternal and neonatal healthcare in FBiH (2) ●Leading causes of death under 5 years in FBiH 2012 Vodeći uzroci smrti kod djece starosti 0-5 godina u FBIH u 2012.godini Leading causes of death under 5 years in FB&H 2012 Tabela 6 Rang Šifra Dijagnoze po 10.MKB Cod Diagnosis by ICD 10 Ukupno Total 1 P22 RESPIRATORNI DISTRES NOVOROĐENČETA 30 2 P21 ASFIKSIJA NOVOROĐENČETA 14 3 P07 POREMEĆAJI VEZANI ZA KRAĆU TRUDNOĆU I MALU TJELESNU TEŽINU NOVOROĐENČETA KOJI NISU DRUGDJE KLASIFICIRANI 11 4 127 DRUGA PLUĆNA OBOLJENJA SRCA 7 5 020 KONGENITALNE MALFORMACIJE SRČANIH ŠUPLJINA I SPOJNICA 6 6 024 DRUGE KONGENITALNE MALFORMACIJE SRCA 6 7 999 NEPOZNATO 5 8 R99 DRUGI BOLEŠĆU-ODREĐENI I NEOZNAČENI UZROCI MORTALITETA 5 9 142 KARDIOMIOPATIJA 10 P20 INTRAUTERINA HIPOKSIJA 4 4 11 S06 INTRAKRANIJALNE POVREDE 4 12 A39 MENINGOKOKNE INFEKCIJE 3 13 P02 FETUS I NOVOROĐENČE UGROŽENI KOMPLIKACIJAMA PLACENTE, PUPČANE VRPCE I MEMBRANA 3 14 P36 BAKTERIJSKA SEPSA NOVOROĐENČADI 3 15 P52 INTRAKRANIJALNO NETRAUMATSKO KRVARENJE FETUSAI NOVOROĐENČADI 3 16 Q21 KONGENITALNE MALFORMACIJE SRČANOG SEPTUMA 3 17 146 SRČANI ZASTOJ 2 18 150 INSUFICIJENCIJA SRCA 2 19 P05 USPORENI RAST FETUSA I MALNUTRICIJA FETUSA 2 KARDIOVASKULARNI POREMEĆAJI PORIJEKLOM IZ PERINATALNOG 20 P29 2 PERIODA OSTALI UZROCI SMRTI 39 UKUPNOITO TAL 158 6 Health Statistical Annual FBiH 2012, Institute of Public Health of Federation Bosnia and Herzegovina (2013)#7G Overall context of maternal and neonatal healthcare in FBiH (3) Izvještaj o porođajima u FBIH u 2012.godini Report on childbirts in FB&H, 2012 Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H Tabela 21 7 Od toga Of which Ukupno broj Od toga Of which uz stručnu prije prolongirana rođenih Total pomoć na vrijeme vremena trudnoća Sekcija number of with assistance full term premature prolonged sections births mrtvorođeno still-born sa TT ispod 2500 weight under 2500 g sa TT ispod 2000 weight under 2000 g 1 2 3 4 5 6 7 8 9 10 Dobne skupine majki Age groups of mothers Ukupno broj porođaja (kol.3-5) Total number of childbirts 0 ispod 15 god under 15 age 6 6 6 0 0 2 6 0 0 0 15-19 god. 791 20-24 god. 4596 4596 1950 4355 41 25-29 god. 7331 7331 6967 200 200 148 48 746 36 6 104 793 5 46 15 141 79 804 4615 28 1594 7385 33 247 96 20 155 55 30-34 god. 5451 5451 5134 206 26 95 96 1439 5522 29 29 183 83 83 33 35-39 god. 2088 2088 1980 80 80 22 22 675 2115 20 86 20 98 46 40-44 god. 424 424 424 380 33 6 196 435 8 29 11 45-49 god. 17 17 15 2 0 8 17 1 1 0 preko 49 god. over 49 age 1 1 1 0 0 0 0 0 UKUPNO/TOTAL 20705 20705 19584 698 359 4823 20889 124 747 306 Health Statistical Annual FBiH 2012, Institute of Public Health of Federation Bosnia and Herzegovina (2013)#8G Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H Overall context of maternal and neonatal healthcare in FBiH (4) Selected HFA Indicator FEDERATION OF BOSNIA AND HERZEGOVINA 2011-2012 8 Indicato Indicator title Pop. group 2011 2012 1. Demographic and socioeconomic #999999 Mid-year population, total Source: Total 2.338.270 2.338.277 Federal Institute for Statistics #999999 Mid-year population, male Source: Federal Institute for Statistics Male 1.145.752 1.160.651 #999999 Mid-year population, female Source: Female 1.192.518 1.177.626 Federal Institute for Statistics # 999998 Live births, total Source: Total 21.161 21.104 Federal Institute for Statistics # 999998 Live births, male Source: Male 10.981 10.962 Federal Institute for Statistics # 999998 Live births, female Source: Female 10.180 10.142 Federal Institute for Statistics # 998006 Fertility rate Source: Total 1,3 1,3 Federal Institute for Statistics #075402 Number of stillborn Total 76 56 Federal Public Health Institute Health Statistical Annual FBiH 2012, Institute of Public Health of Federation Bosnia and Herzegovina (2013)#9G Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H Overall context of maternal and neonatal healthcare in FBiH (5) ●Maternal and child health 9 Indicator Indicator title Pop. 2011 2012 group Total 4.598 4.823 #4281 Number of caesarean sections Federal Public Health Institute #4280 Caesarean sections per 1000 live births Federal Public Health Institute Total 217,28 232,26 #4290 % of live births, weighing 2500 g or more Federal Public Health Institute Total 95,42% 94,40% #4300 % of pre-term deliveries Total 3,73% 3,40% Federal Public Health Institute Health Statistical Annual FBiH 2012, Institute of Public Health of Federation Bosnia and Herzegovina (2013)#10G Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H 10 Policies, strategies, guidelines.. Policy on Early Childhood Development in the Federation of Bosnia and Herzegovina (Government of FBiH, May 2012); Policy for Improving Child Nutrition in Federation of Bosnia and Herzegovina (Government of FBiH, February 2013); Framework Policy for Early Childhood Development in Bosnia and Herzegovina ("Official Gazette of Bosnia and Herzegovina❞ No. 36/12); Strategic Plan for Improving Early Childhood Development in Federation of Bosnia and Herzegovina 2013-2017 (Government of FBiH, 2012); Nutrition Guidelines for Children ages 0 to 3 in FBiH 2013- 2017 (Government of FBiH, September 2013).#11G Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H 11 Basic Documents Governing the Activities - Federal Ministry of Health Law on Health Care ("Official Gazette of the Federation BIH", No. 46/10) Law on Health Insurance ("Official Gazette of the Federation BIH", No. 30/97, 7/02 and 70/08) Law on Rights, Obligations and Responsibilities of Patients ("Official Gazette of the Federation BIH", No. 40/10) Law on Pharmacist Activity ("Official Gazette of the Federation BIH", No. 40/10) Law on Blood and Blood Components ("Official Gazette of the Federation BIH", No. 9/10)) Law on Transplantation of Organs and Tissues for Purpose of Medical Treatment ("Official Gazette of the Federation BIH", No. 75/09) Law on Medicaments and Medical Aids ("Official Herald of BIH", No. 58/08) Law on Protection of Population from Contagious Diseases ("Official Gazette of the Federation BIH", No. 29/05) Law on Protection of Persons with Mental Disorders ("Official Gazette of the Federation BIH", No. 37/01 and 40/02) Law on System for Improvement of Quality, Safety and on Accreditation in Health Sector Disorders ("Official Gazette of the Federation BIH", No. 59/05) Law on Restricted Use of Tobacco Products ("Official Gazette of the Federation BIH", No. 6/98, 35/98 and 11/99) Law on Sanitary Appropriateness of Food and Articles for General Use ("Official Gazette of the R BIH", No. 2/92 and 13/94) Law on Marketing of Poisons ("Official Gazette of the R BIH", No. 2/92) and 13/94)) Law on Health Data Records ("Official Gazette of the R BIH", No. 2/92) and 13/94) Law on Radiation and Nuclear Safety in Bosnia and Herzegovina ("Official Herald of BIH", No. 88/07) Law on Prevention and Eradication of Stupefying Drugs Abuse ("Official Herald of BIH", No. 8/06))#12Q Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H Strategies.. Strategic Plan for Improving Sexual and reproductive Health in Federation of Bosnia and Herzegovina (Government of FBiH, 2010); Strategic Plan for Developing Primary Health Care in Federation of Bosnia and Herzegovina (Federal Ministry of Health); Policy - Youth and Health in Federation of Bosnia and Herzegovina (Federal Ministry of Health); Strategic Plan for Health care Reform, 2008-2018. (Federal Ministry of Health). 12#13Q Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H 13 Development of BFH Accreditation standards Accreditation standards include a total of 14 standards and 66 criteria. These are based on UNICEF's "Ten steps to successful breastfeeding" and separated into tem chapters: 1. Breastfeeding policy (1 standard, 6 criteria); 2. Staff training (1 standard, 7 criteria); 3. Information on breastfeeding (1 standard, 5 criteria); 4. First contact and initiation of breastfeeding (2 standards, 6 criteria); 5. Breastfeeding and maintaining lactation (4 standards, 19 criteria); 6. Infant nutrition (1 standard, 9 criteria); 7. Rooming-in/bedding-in of mother with baby (1 standard, 3 criteria); 8. Breastfeeding "on demand" (1 standard, 4 criteria); 9. Abstaining from using pacifiers (1 standard, 3 criteria); 10. Support group for mothers (1 standard, 4 criteria).#14Q Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H Main achievements Two accredited maternal wards; Two maternal wards waiting on decision; ●By end of 2014/beginning of 2015 we expect to have 10 maternity wards accredited (against BFH standards) in FBiH. 14#15Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H 15 Accreditation - external assessment Akorgo 522- Hour Save " VIZILA T#16G Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H 16 Further steps and activities Accreditation and reaccreditation of maternity wards in FBiH; ● Expand activities at the level of primary healthcare ("schools for pregnant women" and postpartum care - nurses in community); ●Accreditation standards for Integrated Early Childhood Development Centers.#17Q Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H 17 Existing quality assurance mechanisms in FBiH (1) CƠ Federal Administration for akaz sertifikacija akaz akreditacija Inspection (Health Inspections); • Certification - AKAZ (mandatory - safety standards); • Accreditation - AKAZ (voluntary - quality standards). -#18G Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H Existing quality assurance mechanisms in FBiH (2) AKAZ - basic functions: • Development of standards; Evidence based clinical guidelines; Performance indicators; Education and training of health professionals. Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation 18#19Q Agencija za kvalitet i Existing quality assurance mechanisms in FBiH (3) akreditaciju u zdravstvu Accreditation standards for: FBiH Agency for Healthcare Quality and Accreditation FB&H Hospitals (rev. 2010); Baby friendly hospitals (rev. 2014) Health Centers (rev. 2013); Family medicine teams (rev. 2012), Centre for Mental Health (rev. 2013), Youth friendly services (2009); • Drop-in centers (2014), ⚫ VCT centers (2014). 19 Certification standards for: ● Pharmacies (2013); ⚫ Health Centers (rev. 2014); Family medicine teams (rev. 2014), Hospitals (rev. 2015). Performance indicators for hospitals (41/12) and health centers (38/8) with methodology (AKAZ, 2014)#20G Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H 20 Expected ways forward ●Federal Ministry of Health (legal framework); Health Insurance Fund (incentives for safety and quality of healthcare); Health professionals (education, training, CME chambers); - ● Patient organizations/associations; • AKAZ - further support development of the Agency; Donors (UNICEF, SDC, WHO, etc.)#21Agencija za kvalitet i akreditaciju u zdravstvu FBiH Agency for Healthcare Quality and Accreditation FB&H AKAZ FBiH Agencija za kvalitet i akreditaciju u zdravstvu u Federaciji Bosne i Hercegovine Adresa: Dr. Mustafe Pintola 1, 71000 Sarajevo, BiH Telefon: +387 33 771 870 Fax: +387 33 771 880 URL: Email: f www.akaz.ba [email protected] https://www.facebook.com/#!/akazbih