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Relations and Communication of the Centres for Mental Health with Other Relevant Stakeholders in Bosnia and Herzegovina.

Author(s) Ahmed Novo1, Sinisa Stevic2, Srdjan Dusanic3, Darko Paranos 4, Vera Kerleta-Tuzovic 5, Nadja Bascausevic6
Affiliation(s) 1Agency for Quality Improvment and Accreditation in Healthcare of Federation of BiH, AKAZ, Sarajevo, Bosnia and Herzegovina, 2ASKVA , ASKVA RS, Banja Luka, Bosnia and Herzegovina, 3Faculty of Philosophy, University of Banja Luka, Banja Luka, Bosnia and Herzegovina, 4Mental Health Project in BiH, MHP BiH, Sarajevo, Bosnia and Herzegovina, 5Agency for Quality Improvment and Accreditation in Healthcare of Federation of BiH, AKAZ, Sarajevo, Bosnia and Herzegovina, 6Agency for Quality Improvment and Accreditation in Healthcare of Federation of BiH, AKAZ, Sarajevo, Bosnia and Herzegovina.
Country - ies of focus Bosnia and Herzegovina
Relevant to the conference tracks Health Systems
Summary Within scope of the Mental Health Project in Bosnia and Herzegovina (BIH) two BIH agencies for safety and quality improvement and accreditation in health care, AKAZ and ASKVA conducted series of training seminars in order to improve the importance, role and visibility of the Centres for Mental Health (CMH) in the health systems, as well as their relations with other relevant stakeholders in health and social systems of Bosnia and Herzegovina. Two surveys at the beginning and the end of the project activities have been performed in order to measure the successes of the training seminars. Final survey results have showed that CMH have improved their importance as well as communication.
Background Activities were conducted within the scope of the Mental Health Project (MHP) in Bosnia and Herzegovina (BIH). The Mental Health Project in BIH is a result of continuous commitment of the health ministries to continue the mental health reform in BIH. The mental health reform was launched in 1996 and focused on community-based care as a contrast to the traditional model which was mainly oriented towards hospital treatment of persons with mental disorders.The overall goal of the Mental Health Project in BIH, in the period June 2010 - December 2013, was to improve general mental health of the population and enhance the capacities of policy makers and competent institutions in complying with European standards in mental health care in BIH.Since 2008, two Agencies for quality improvement AKAZ and ASKVA were involved in training and accreditation of health centres in field of mental health with the aim to improve the quality of provided care. Therefore they were selected to perform training for representatives of relevant stakeholders in order to improve importance, role and visibility of the Centres for Mental Health, as well as their relations with other relevant stakeholders in the health systems of Bosnia and Herzegovina.
Objectives The objectives of the Mental Health in BiH Project from the period June 2010 to December 2013 were as follows:1.Improved administrative and legislative framework to enable efficient operations and processes in mental health care in both BiH entities, Federation of Bosnia and Herzegovina and Republika Srpska.
2.Persons with mental problems have access to improved and better quality services of mental health care at the community level.
3.Provision of high-quality mental health services at the community level supported as a priority of the reform process by the management structures in Community Health Centres.
4.To strengthen the capacities to fight against stigmatisation and discrimination related to mental disorders.Within the objective 3, the specific objectives include: a) Improved understanding of managers of DZs and centres for social welfare on the importance and role of mental health centres within DZ organizational structure and b) Establishment of improved cooperation between centres for mental health and other services within primary health care centres, other relevant sectors and local community.
More precisely, AKAZ and ASKVA needed to conduct a series of training seminars in order to improve the importance, role and visibility of the Centres for Mental Health in the health systems, as well as their relations with other relevant stakeholders in health and social systems of Bosnia and Herzegovina. It was also planned to perform two surveys at the beginning and the end of the project activities in order to measure the successes of the training seminars and to examine whether the training made a difference in the initial and final report, emphasising the following questions and tasks:
•Assessment of the current human resources and technical capacities of centres for mental health;
•Assessment of the cooperation established among centres for mental health and other relevant stakeholders in the sector (family medicine teams - FMT and primary healthcare centres - PHC as a whole, psychiatric clinics/wards, centres for social welfare - CSW, local community);
•Definition of the major challenges in inter-sectoral and intra-sectoral cooperation among the aforesaid stakeholders;
•Identifying the respondents’ attitudes toward mental health (centres for mental health, working professionals, individuals with mental disorders);
•Assessment of the respondents’ acquaintance with basic terms and data in the field of mental health.
Methodology Within the MHP in BiH, Agencies for healthcare quality, AKAZ and ASKVA, conducted a series of surveys on “Relations and Communication of the Centres for Mental Health with Other Relevant Stakeholders in Bosnia and Herzegovina. Both Agencies have compared results of the baseline and final survey on respondents’ view and evaluation of the capacity, role and importance of the Centres for Mental Health and their relations with other relevant stakeholders. AKAZ and ASKVA applied different research methodologies. AKAZ developed five questionnaires for the survey: for mental health centres staff, for social work centre staff, for DZ management, for members of the family medicine teams and for staff from psychiatry departments/clinics. All participants completed questionnaires anonymously and questionnaires did not contain questions about the identity of respondents. Questionnaires had seven parts: data on respondent, cooperation between CMH and management of DZ, cooperation between CMH and family medicine teams in DZ, cooperation between centre for mental health and and psychiatry department/clinics, cooperation between CMH and centred for social work, cooperation between centre for mental health and other services and part seven was for comment, suggestions and questions in an open end format. The first survey was conducted in January-March 2012 and the second was conducted in February 2013. Questionnaires were sent by e-mail to the survey participants who filled it in and sent it back in electronic format or as hard copy. ASKVA conducted interviews in two different phases, at the beginning of the first round of seminars and at the end of project implementation, during the third round of seminars. There were four rounds of trainings and seminars in whole, organised regionally (Banjaluka region, Herzegovina region and Teslic region). The baseline survey was conducted in December 2010 and the final survey was conducted in November 2011. The same respondents participating in the survey, fulfilled questionnaire both at the beginning and at the end of the survey and their responses were compared. The interviews were conducted by the RS Agency’s staff. The survey was quantitative, since it was questionnaire based. Respondents needed approximately 30-45 minutes to fill in the survey questionnaire. Data processing was completed in SPSS statistical software. Responses to the survey questions were presented in form of frequencies, percentages and arithmetic averages.
Results In Federation of BIH AKAZ conducted two surveys in the period from January 2012 till March 2013. 40 organisations participated in the first survey from primary health care level (12 DZ, 14 CMH and 14 FMT), 16 CSW and 6 hospitals. 60 organizations from primary health care level (19 DZ, 24 CMH and 17 FMT), 9 CSW and 5 hospitals participated in the second survey.
Analysis of the results of cooperation between CMH, FMT and management of DZ shows obvious progress in cooperation. Significant contribution provided CMH with improved service through the use of accreditation standards and development of cooperation protocols, working procedures and better communication with management of DZs and FMTs. Furthermore, cooperation between CMH and CSW was also improved. Analysis of the results shows the progression of attitudes of both institutions. Improvement is especially noticeable in the area of general cooperation and frequency and quality of communication. Cooperation between
CMH and psychiatry departments/clinics are also ameliorated (efficiency of the referral system, role and importance of CMH and psychiatry departments, etc.). None of the results from all stakeholders and participants in the survey show that disagreement in general cooperation, frequency in communication and definition of mutual relationships are still present.
In RS, ASKVA conducted the first survey in December 2010, using the sample of 77 respondents and the second was conducted in November 2011 with the sample of 61 respondents. Results show that the capacities of the Centres for mental health (CMH) are improved when compared to the initial survey and respondents are more pleased with cooperation they have between CMH and other institutions. The biggest impacts are related to regular communication and signed protocols of cooperation. The following challenges are recognized in inter-sector cooperation: development of better communication, organization of meetings within healthcare centres, better positioning of CMH within health centre, development of procedures and work standards, more intensive work and better cooperation in smaller communities.
Challenges in the intra-sectoral communication are as follows: better communication and information, defining and realization of protocol on cooperation, provision of more education/training for all employees. Participants have positive relations towards mental health and there are no open signs of stigmatization.
Conclusion Summarized conclusions in regards to the survey on “Relations and Communication of the Centres for Mental Health with Other Relevant Stakeholders in Bosnia and Herzegovina” are as follows:
• CMH capacities are improved when compared to the initial survey. Respondents are satisfied with premises, furniture and technical equipment as well as professional instruments and additional education.
• Respondents are mainly satisfied with cooperation of CMH and other institutions in the final survey. They are the most pleased with the cooperation with organizational units within healthcare centres and the least happy with cooperation with associations of beneficiaries.
• The biggest leap forward was made in the final survey with regard to more regular communication and signed protocols of cooperation between CMH and CSW. Besides, there is a progress in regular communication between CMH and family medicine teams.
• There is a positive attitude of participants towards the mental health, CSW and psychiatric clinics.
• At the end of project, the number of those who think they knew the Strategy of Mental Health Development increased. Besides, participants evaluated that the Strategy was better implemented in practice.
• Challenges in intra-sector cooperation are: development of better communication and organization of more meetings within healthcare centres, better positioning of CMH within healthcare centres, development of work procedures and standards, intensified work and cooperation in smaller communities.
• Challenges in inter-sector cooperation are as follows: development of better communication and information, defining and realization of protocols on cooperation, provision of better education for employees.A complex organisational health care structure and the complex political structure in BIH may jeopardise the project implementation in the planned timeframes. Different understanding of roles and functions by mental health authorities at different levels could be also be one of the risks. Through the intra- and inter-sectoral cooperation, the Project should develop clear allocation of responsibilities between the institutions and stakeholders involved. Clear commitment of the BIH health care authorities to the sector reform and kind support and joint efforts of Donors (SDC and the Swiss Cantons) and the ensured domestic ownership of the project should guarantee the sustainability of the reform process.

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