Governance

The Bosnia and Herzegovina Constitution delegates responsibility for the provision of health care to the two entities, the Federation of Bosnia and Herzegovina and Republika Srpska, as well as to Brčko District of Bosnia and Herzegovina. At the state level, there is no Ministry of Health, although the Bosnia and Herzegovina Ministry of Civil Affairs has the authority to coordinate health matters nationally, as well as international strategies related to health.

There are a total of 13 health insurance funds and 13 ministries or departments responsible for the provision of health services, directly reflecting the constitutional structure of the country.

The Federation of Bosnia and Herzegovina Constitution defines health care as a shared responsibility of the entity and its cantons, supported by eleven ministries of health and eleven health funds, one in each canton, plus the entity-level “Solidarity Fund.” The Solidarity Fund was established to equalize access to the most complex health services and to finance priority public health programs such as vaccination. However, service provision varies significantly across cantons in terms of access, quality, and costs, with some cantons charging annual membership fees and co-payments for a broad range of services.

Republika Srpska has one Ministry of Health and one health fund, while Brčko District of Bosnia and Herzegovina has a separate Department of Health and Other Services and a separate Unit of Health Insurance.

All three administrative units that make up Bosnia and Herzegovina implement their own health care laws, while health development strategies are divided according to the types of health care and are embedded in different sectoral policies.

The health system consists of health insurance funds, medical institutions, and health professionals. The structure of health institutions in both entities is inherited from the former Socialist Federal Republic of Yugoslavia (SFRY) and includes clinical centers, specialist and general hospitals, health centers, and smaller outpatient clinics. There is also a network of public health institutes responsible for monitoring and surveillance, health protection, disease prevention, and the promotion of healthy lifestyles.

These institutes are geographically distributed. The central Federation of Bosnia and Herzegovina Public Health Institute is located in Sarajevo, while cantonal institutes are based in Central Bosnia, Posavina, Sarajevo, Tuzla, and Zenica. In Republika Srpska, the central Public Health Institute is located in Banja Luka, with five regional branches across the entity. Health insurance in Republika Srpska is centralized and managed at the entity level, which is why the health insurance system in Republika Srpska is often considered more favorable for insured persons compared to the system in the Federation of Bosnia and Herzegovina, which is decentralized and dependent on the cantons.

Health in Brčko District of Bosnia and Herzegovina is regulated through the system of the Brčko District Government, in line with the specific organization of this local community. Public health institutions are located in the city of Brčko, while each rural local community has its own health center, where citizens can access primary and emergency health care. Although public health institutions operate independently of the entity structures, the Brčko District’s Department of Health and Other Services has signed cooperation agreements with health institutions from both entities, and with neighboring cross-border states, whose citizens may use health services not available in Brčko District.

Cross-sectoral Cooperation

In Bosnia and Herzegovina, intersectoral cooperation in the area of health and youth welfare takes place within a multilayered institutional framework. According to Article 15 of the Law on Ministries and Other Bodies of Administration of Bosnia and Herzegovina, the Bosnia and Herzegovina Ministry of Civil Affairs is responsible for coordinating the activities and plans of the entity authorities, defining basic principles of cooperation, and developing international-level strategies in the fields of health, social protection, pensions, education, employment, culture, and sports.

Within the Ministry of Civil Affairs, the Department for Health coordinates the health sector at the state level and represents Bosnia and Herzegovina in international health initiatives, including cooperation with institutions such as the WHO and the European Commission. In the context of youth, the Commission for Coordination of Youth Issues plays a particularly important role, bringing together representatives from the Federation of Bosnia and Herzegovina, Republika Srpska, and Brčko District of Bosnia and Herzegovina to align policies relevant to health, mobility, and mental well-being of young people.

At the entity level, responsibility for youth health lies with ministries responsible for youth affairs. In Republika Srpska, this is the Ministry of Family, Youth, and Sports, while in the Federation of Bosnia and Herzegovina it is the Ministry of Culture and Sports in cooperation with cantonal bodies. These ministries are tasked with designing and implementing programs aimed at improving youth health and well-being, including the promotion of healthy lifestyles, violence prevention, and the development of sports and educational programs. At the local level, youth councils function as advisory bodies, enabling young people to voice their needs and influence local policies.

Nevertheless, despite the existence of formal cooperation mechanisms, challenges in coordination remain. Fragmented governance, overlapping competencies, and politicization of services hinder consistent policy implementation across the country. According to the 2024 OECD SIGMA report, weak inter-institutional coordination is a significant obstacle to the quality delivery of public services, including health care.

In response to these challenges, a public administration reform was launched in Bosnia and Herzegovina in late 2024 with the aim of improving vertical and horizontal coordination, standardizing professional services, and strengthening evidence-based policymaking. The reform foresees strengthening the capacities of public servants and establishing more effective systems for collecting, sharing, and using health data, particularly in areas of special importance for young people, such as mental health and addiction prevention. These reforms are in their initial implementation phase and require ongoing political commitment and donor support.

In the Brčko District Bosnia and Herzegovina, intersectoral cooperation is institutionalized through local interdepartmental teams that connect the Department of Health and Other Services, the Department of Education, and the Sub-department for Social Protection. Brčko District of Bosnia and Herzegovina also participates in several international programs, including projects within the EU4Health program and the Youth Mental Health Initiative, which are particularly focused on integrating health and education policies and improving the availability of counseling services in schools and youth centers.