Policy framework

Bosnia and Herzegovina is a country with a complex administrative structure, where the Federation of Bosnia and Herzegovina, Republika Srpska, and Brčko District of Bosnia and Herzegovina each have their own legal and institutional frameworks for justice and social protection systems. While structurally similar, these systems primarily provide reactive rather than preventive services, which limits early response to health risks among children and youth. There is no overarching legislative framework at the state level for child protection that offers a strategic vision for strengthening the protective environment, resulting in a fragmented approach and insufficiently coordinated activities between different levels of government.

The implementation of existing laws and strategies is hindered by limited budgetary, human, and institutional capacities, and data on budget allocations and the use of funds for child protection are insufficiently transparent. The lack of preventive action and holistic approaches prevents early detection and support for children and youth facing health risks, including violence, neglect, poverty, and discrimination.

Stakeholders

An important step in improving child social protection services was the development of standardized case management tools in social welfare centers (CSRs). Entity and cantonal ministries responsible for social protection, in cooperation with the academic community, developed the Guidelines for Case Management in Child Protection in the Federation of Bosnia and Herzegovina and Republika Srpska in 2018. These guidelines have been introduced in all municipalities in Republika Srpska as well as in several cantons in the Federation of Bosnia and Herzegovina.

Significant improvements have also been made in establishing an effective foster care system through the adoption of relevant laws and regulations, professionalization of social service staff involved in foster care, and the training and certification of foster carers.

However, the main challenges in further improving child (and family) protection relate to the fact that the social protection system is stretched between a “generous” (in intent) list of social benefits for vulnerable groups and reactive child protection services that are activated only when there is “evidence” of abuse. Available services are often insufficient or severely limited in their capacity to provide proactive preventive and supportive services between these two extremes. Currently, available services are mostly limited to financial assistance, in-kind support, limited social work services, foster care, and institutionalization of children.

To enable social welfare centers to provide more effective protection, additional human, financial, and technical resources are required.

Guidance to stakeholders 

The competent state-level institution is the Bosnia and Herzegovina Ministry of Civil Affairs, responsible for defining basic principles for coordinating and harmonizing entity plans and defining international strategies.

At the Federation of Bosnia and Herzegovina level, the Ministry of Health and the Department for Social Protection and Protection of Families and Children within the Ministry of Labor and Social Policy are responsible for the well-being of children and youth. In Republika Srpska, the Department for Social, Family, and Child Protection within the Ministry of Health and Social Protection is competent for health and social security issues.

No specific youth health policy exists at either the state or entity level. The only currently valid strategies that partially cover this area are the Federation of Bosnia and Herzegovina Social Inclusion Strategy 2021–2027 and the Republika Srpska Social Inclusion Strategy 2021–2027. Both strategies address child and youth health and well-being alongside other issues and recognize the importance of young people as a social resource.

Target groups

According to the Situation Analysis of Children in Bosnia and Herzegovina (2020), over half of the population was at risk of poverty and social exclusion as early as 2010, with no significant changes by 2024. Children remain one of the most vulnerable groups. In 2011, 30.6% of children lived below the poverty line compared to 23.4% of the total population. While Republika Srpska made progress through reforms in child allowance legislation, the Federation of Bosnia and Herzegovina only adopted the Law on Material Support to Families with Children in 2020.

Additional vulnerabilities affect families in rural areas, Roma families, and families with children with disabilities, who often lack access to quality health and social protection services.

Funding

As noted in the Situational Analysis of Children in Bosnia and Herzegovina, total health expenditures in Bosnia and Herzegovina have significantly increased since 2000, reaching 9.3% of GDP in 2016. Child health shows signs of improvement. However, despite constitutional provisions, quality healthcare is not universally accessible, especially for vulnerable groups such as Roma. Fragmented service delivery, high spending on medicines, and inefficiencies in insurance and hospital systems threaten the sustainability of healthcare services.

Approximately 58% of health funds in Bosnia and Herzegovina is allocated to hospital treatment and medical devices for outpatient care, while only 1.8% is spent on preventive healthcare. In 2016, out-of-pocket payments accounted for 29% of total health expenditures. It is likely that the poorest households forego basic healthcare because they cannot afford it. Health insurance coverage among Roma is sometimes not realized for various reasons, including lack of required documentation.

The number of medical personnel in relation to the population is significantly below the EU average, which hampers adequate access and timely provision of healthcare services. Planning and coverage for vulnerable groups remain problematic, with significant exclusions persisting. Varying levels of expertise and knowledge among healthcare workers further undermine trust between patients and medical staff and lead to uneven outcomes, while the absence of unified standards across the country structurally discriminates against populations in rural areas.