1. Child Friendly Hospital in Bosnia and Herzegovina Brussels 23 March 2010

2. Project “Child Friendly Hospital” Implemented in the period 1998- 2004 Financed by UNICEF, implemented by HealthNet International (Dutch International Organization) Partners: Wilhelmina Hospital Utrecht (prof Wim Wolters), entity and cantonal Ministers of Health and Department of Health Brcko District (10 Ministries), Pediatric Associations in B&H Hospitals: 13 in total Sarajevo, Banja Luka, Mostar 2 hospitals, Tuzla, Travnik, Doboj, Bihac,Prijedor, Brcko, Zenica, Livno and Trebinje

4. Overall objective To increase quality of health care for children in paediatric hospitals/wards in B&H in line with the UN Convention on the Rights of the Child and the European Association for Children in Hospital Charter (EACH)

5. 5 Complexity of the task 1. There are at least two beneficiaries (a child and a parent) 2. Organization of pediatric wards (according to diseases, treatment together with adults) 3. The beneficiaries are in different developmental stage (babies up to age of 15) 4.Insufficient understanding of psychological needs of patients and parents 5.Lack of team work for this kind of assistance (child psychologist, pediatrician, nurse, social worker, play leader)

6. 6 EACH Charter 1 Article 1- Children shall be admitted to Hospital only if the care they require cannot be equally well provided at home or on a day basis. Article 2 - Children in hospital shall have the right to have their parents or parent substitute with them at all times Article 3 –(1) Accommodation should be offered to all parents and they should be helped and encouraged to stay. –(2) Parents should not need to incur additional costs or suffer loss of income –(3) In order to share in the care of their child, parents should be kept informed about Ward Routine and their active participation should be encouraged

7. EACH Charter 2 Article 4 (1) Children and parents shall have the right to be informed in a manner appropriate to age and understanding. (2) Steps should be taken to mitigate physical and emotional stress. Article 5 (1) Children and parents have the right to be informed about participation in all decisions involving their Health care. (2) Every child shall be protected from unnecessary medical treatment and investigation

8. EACH Charter 3 Article 6 (1) Children shall be cared for together with children who have the same developmental needs and shall not be admitted to adult wards. 2) There should be no age restrictions for visitors to children in hospital. Article 7 Children shall have full opportunity for play, recreation and education suited to their age and condition and shall be in an environment designed, furnished, staffed and equipped to meet their needs

9. EACH Charter 4 Article 8 Children shall be cared for by staff whose training and skills enable them to respond to the physical, emotional and developmental needs of children and families Article 9 Continuity of care should be ensured by the team caring for children. Article 10 Children shall be treated with tact and understanding and their privacy shall be respected at all times.

10. 10 Results and outputs Child friendly environment in 13 hospitals introduced Multidisciplinary teams formed or initiated Daily treatment in hospitals promoted More than 80 staff in hospitals trained in: developmental psychology, communication skills, parenting, holistic approach towards patient’s treatment; painful procedures and death of child in hospital Some 15 professionals trained for trainers A network of 50 professionals from 13 hospitals established and functional, extended networks with primary health care, CSW, kindergartens, NGO-s established Certain number of staff in all hospitals (minimum 1 in each ) trained for play leaders

11. Results and outputs Sets of leaflets developed, printed and distributed to hospitals: Information leaflets for admission to hospital for parents Guidebooks for parents of children with chronic disease Guidebooks for parent’s self-organizing (establishment of associations) Guidebooks for medical professional “How to deal with Medical Procedures” Video- Psycho- social preparation of children for painful procedures recorded Newsletter issued 6 times during project life

12. Results and Outputs 13 hospital wards refurbished and equipped with playrooms, and 6 hospitals with playgrounds Standards of equipment developed Professional literature and psychological tests distributed to all 13 hospitals Continued or long presence of parents enabled (beds and chairs for parents provided, wherever possible visiting time extended and visit of peers enabled) Network of volunteers introduced (students in medical schools, psychology, pedagogy, parents etc.) Assistance to school children in interrupted education during hospital treatment introduced

13. Results and outputs Parents involvement in health care increased 3 new associations of parents of children with chronic diseases established A network of parents associations enhanced Communication and cooperation between children, parents and staff improved

14. Conclusions Medical treatment of children in hospital is more effective if there is adequate care for children's psychological well being Role of parents in: providing support to their children, communication with children, basic care for children, stress reduction, advocating for rights of children is enormous. Children are more receptive to different kind of information, different treatment procedures etc. if the staff is adequately approaching them Child friendly atmosphere can be introduced in hospitals with small investments Motivation of staff in hospitals to introduce child friendly approach and atmosphere is quite easy since they are “helpers”

15. Recommendations Authorities - harmonization of relevant legislation with conventions and requirements for human rights Allocation of funds for support to holistic approach Political and human support Management in hospitals -Internal rules and procedures to be harmonized -Support to multidisciplinary approach -Investment and support to training of staff -Support children and parent’s in exercising of their rights -Involve volunteers -Financial support Medical staff - Initial and in-service training of staff to be changed -More time allocated to communication and direct work with parents and children -Full support to maintenance of the model

16. Recommendations Parents Information gathering about rights of children and contribution to raising of awareness Self-organizing Voluntary and other activities Financial contribution Children -Information gathering and sharing -Helpers to other children -Active participation in their own treatment

17. Recommndations NGOs, other partner institutions (CSW, universities, schools, kindergartens, association of medical professionals) broadening scope of their activities, introducing new training modules in curriculum Society in general Raising awareness campaigns Support and stimulate voluntary activities Financial support

18. Thank you Jadranka Mihic Task Manager Social Cohesion and Development EU Delegation to Bosnia and Herzegovina Skenderija 3a, 71 000 Sarajevo Tel: +387 33 254 767 Fax: +378 33 666 037 e-mail:jadranka. mihic@ec.europa.eu