TB financing in BiH: current situation
and challenges to foster budgets in
countries transiting out of the Global
Fund

Introduction
• Population: 3,829 mil.
• Unemployed: 552.363
• GDP per capita: 4.656 USD (103. WB)
• 13 Health Funds (without state level HF)
• 2 entity MoHs, 1 DH BD and 10 Cantonal MoHs
• Out of pocket health expenditure 97.3%-96.3%

Before Global Fund
• Started in 2006 with HIV R5 supported grant,
followed with TB R6 supported grant late 2007
• 2007 Number of TB cases registered in BiH 2.373
• Incidence: 53/100.000
• Low DOT coverage, Insecure funding for TB drugs
• Weak network of laboratories
• High number of persons without health insurance
• Unavailable data on HS financial contribution

Before Global Fund
• Without:
• proper infection control measures in laboratories
and TB departments
• proper laboratory equipment
• Isolation rooms for MDR patients
• Insecure procurement of TB drugs
• Weak support to target population
• Weak NVO/CSO activities

Global Fund support
• Developed and approved Tuberculosis Programme
(FBiH and RS)
• Education of health professionals all over the country
(doctors and nurses)
• Engaged NGOs to support health system to provide
access to hard to reach population
• Organized screening for target population and access
to health service (without health insurance-HS cover)
• Excellent expert and technical support

Global Fund support
• Strengthen network of laboratories with new
technologies and equipment (maintenance and
diagnostic tests)
• IC measures, rehabilitation of TB wards by GF,
maintenance by HS
• Established isolation rooms and laboratories according
to international standards
• Strengthened lab network provides fast diagnostic
results, established QA/QC system with SNRL

WHO Country data on financing - 2013
These data were unavailable before 2012

Finance profile

Funding
1490 1420 1261 1190 1160 1131
8,139,550.00
11,845,869.13
12,893,073.08
10,173,162.00
8,813,206.46 8,813,206.46
2,652,552.41
3,577,193.52
5,393,118.00
2,160,423.00
1,518,843.00
778,805.00
2011 2012 2013 2014 2015* 2016*
Funds used for Tuberculoses control
Programmes in BiH (all sources in BiH),
*forecast for 2015&2016
BiH kontribucija (USD) GF kontribucija (USD)

Funding (%)
75% 77%
71%
82%
85%
92%
25% 23%
29%
18%
15%
8%
2011 2012 2013 2014 2015* 2016*
Share of expenditure of BiH Health Care System and Global Fund in the period
2011 - 2016
Procentualno učečće BiH Procentualno učečće GF

HSS
• Hospital costs ( including human resources)
• Maintenance of equipment (old)
• Maintenance of equipment and rehabilitated premises
• IC measures
• Drug procurement & management
• NGO support
• E-data base maintenance and upgrade
• Diagnostic costs

Road to success
2007
• Number of TB cases 2.373
• Incidence 53/100.000
• Without: active screenings,
NGO/CSO support, laboratory
network
• Limited access to HS without
health insurance
• Payment of services for
suspects
2013
• Number of TB cases 1.261
• Incidence 46/100.000
• Regular active screening, NGO
involvement, strong laboratory
network with rapid results
• Access to HS and HI
• No payment of services for
suspects

Road to success
0
500
1000
1500
2000
2500
3000
3500
4000
4500
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
TB case notification in BiH Estimation of number of TB cases at 2,5% decreasing rate annualy
Benefit gained through GF support in terms of decline of TB burden in BiH in the period 2007-2017

Positive impact
GF
• Mechanisms
• Monitoring and evaluation
• High standards of
performance evaluation
• Partnership of GO and
NGO
BiH
Partnership of all
stakeholders
Strong Public Health system
Exchange of experience
Strong commitment to
project aim
All as ONE

Comparison of TB prevalence and incidence
2013
Indicator Prevalence Incidence
EU
Slovenia 9.2 7.5
Croatia 18 13
Hungary 29 18
Romania 123 87
Bulgaria 37 29
non-EU
BiH 69 46
Serbia 28 18
Montenegro 25 21
Macedonia 25 17
Albania 27 18

Current budgets for health
• May 2014 Floods
• Lack of investment for prevention activities, DOT
coverage and food/hygienic packages
• Weak, but with funds for hospital costs,
diagnostic (-), HR (-)
• Planning for drugs
• Funds for NGOs from MHRR (Roma Action Plan)

To be continued…..
• SAT/DOT
• NGO activities (prior analyze of new needs)
• Improved cooperation between NGO/CSO and
PHIs
• Treatment and quality diagnostic services
• Screening
• E-reporting

Chalanges
• To identify method for procurement fo FLDs and
SLDs
• Surveys
• Annual meetings of all NTPs
• DST coverage rate

Thank you for your attention!