The Care Continuum for Hypertension and Diabetes in the Federation of Bosnia and Herzegovina : Findings from a Cascade Analysis

Overview & Synopsis

The health care system in the Federation of Bosnia and Herzegovina (FBiH) is decentralized and organized across multiple administrative levels. Governance and financing responsibilities are largely held at the cantonal level, which leads to variation in service organization, resource allocation, and data management across regions. Health services are delivered through a network of primary health care (PHC) centers, hospitals, and specialized facilities, with primary care intended to serve as the first point of contact and the coordinator of patient care. However, fragmentation in governance, financing, and information systems can create challenges for coordinated service delivery, consistent implementation of policies, and comprehensive monitoring of health outcomes across the system. The lack of interoperability between systems also constrains data sharing and analysis while placing additional administrative burdens on health care providers. As a result, opportunities for comprehensive surveillance, quality improvement, and evidence-based health system planning remain limited. This insufficient interoperability between primary and secondary systems is particularly important for noncommunicable diseases (NCDs) management, including cardiovascular diseases (CVDs) and diabetes, considering that these conditions are primarily managed within the PHC system, while more complex cases are referred to secondary and tertiary health care facilities for specialist care.