1. health promotion and prevention of NCDs in community settings
Embassy of Switzerland in Bosnia and Herzegovina
Regional Learning Event on Health 2015, Bishkek
South-Asia Division – Frank Wiederkehr – September 2010
Module on
health promotion and prevention of NCDs in community settings
Mental Health Project in Bosnia and Herzegovina
Presenter: Maja Zaric

2. Reform of mental health (MH) care system in B&H
Reform objectives:
Deinstitutionalisation of MH care services
Development of community-based MH care services
Focus at prevention, early detection and early intervention => primary health care level
South-Asia Division – Frank Wiederkehr – September 2010
Reform achievements:
Created network of 70 MH care centers at the community level
Interdisciplinary teams at community level

3. Swiss support – Mental Health Project
Project started in 2010, 2nd phase ongoing
Project partner: Local NGO - Association XY
Facilitation approach – implementation by health institutions and CSOs; strong ownership by local health authorities
Areas of intervention:
Governance of community-based services
Quality and scope of service provision
Fighting stigma and discrimination at community level
South-Asia Division – Frank Wiederkehr – September 2010

4. Community approach
Strong focus at prevention, early detection and early intervention
Key stakeholders
Strategic leadership: Ministries of Health, Public Health Institutes
Community programmes and implementation: Community MH Care Centres, Associations of service users, NGOs, schools, community organisations, media
Target group: Persons with MH problems, persons at risk, general population
Interdisciplinary approach: Community MH Care Workers as focal points for community networking (care coordination)

5. Implementation of community programmes
1) Planning: Public Health Institutes, Community MH Centers, service users, CSOs:
Analysing key issues in the community (discriminatory practices and MH factors)
Drafting community implementation plan for promotion and prevention

6. Implementation of community programmes (cont.)
2) Collaborative programmes of MH workers and users’ associations in the community, e.g. :
Discussion groups in schools (students, parents)
Support to school pedagogists and teachers (non-violent communication, detecting students at risks, peer violence)
Including persons with MH problems in mainstream activities
Coordination meetings with other services (employment, social welfare, family medicine, NGOs)
Promoting community-based MH services (open door day, public presentations, media)

7. Result achieved so far
Revised MH nomenclature - promotional-preventive and outreach services raised to 28% of all MH services
Developed quality standards for MH care - structured patient-centred cooperation with other community services and organizations (FM, outpatient facilities, social welfare, schools, NGOs).
1’803 (f 49%) persons with severe MH disorders in 65 municipalities benefit of coordinated community services: hospitalisations reduced for 28-55%, significant recovery improvement at 82.3% rate
1’762 (f 46%) children and youth benefiting from MH promotion and early detection services at schools in 18 municipalities

8. Challenges Sustainability:
Insufficient funding for promotional-preventive services (public health) and particularly for MH ones
Interventions are integrated in legal framework but support to practical implementation is weak
Managers of health institutions have different priorities
MH workers are overburden and frequently work on prevention after working hours
Lack of incentives for MH workers
Paternalistic approach of service providers towards service users’ associations
Media report rather negatively about MH issues and/or are not interested in those at all

9. Thank you for your attention!