The Care Continuum for Breast Cancer 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. Services are delivered through a network of primary health care centers, hospitals, and specialized facilities. Primary care is designed to serve as the first point of clinical contact and the coordinator of patient care. This initial level consists of local family medicine centers (ambulantas), which are responsible for preventive measures and the identification and referral of patients displaying cancer symptoms. The second tier involves community health care units, while the tertiary level encompasses specialized hospitals. These higher-tier facilities provide comprehensive oncology services, including chemotherapy, radiotherapy, and surgical interventions. Reflecting the broader health care system, patient record management in FBiH remains fragmented. Patient data are typically stored across multiple disconnected platforms at different levels of care. This fragmentation severely limits the ability to track patients across the continuum of care, reduces the reliability of routine health data, and complicates the monitoring of disease outcomes and service utilization. There is currently no documented evidence regarding the proportion of these fragmented data sources that have been digitized. Furthermore, a lack of interoperability between systems constrains data sharing and analysis while increasing the administrative burden on providers. Consequently, opportunities for comprehensive surveillance, quality improvement, and evidence-based planning remain limited. This lack of integration between primary and secondary systems is particularly detrimental to the management of noncommunicable diseases (NCDs), which require seamless transitions between primary management and specialist intervention.