7.6 Mechanisms of early detection and signposting of young people facing health risks
The three administrations of FBiH, RS and BD BiH each have a justice and social welfare system with similar structures. Structurally, the child protection systems deliver services that are mainly responsive, with challenges to promoting preventive services and initiatives. Child protection issues are covered by different laws and strategies at entity/cantonal level; there is no overarching normative framework for child protection that outlines a strategic vision for strengthening the protective environment of children in BiH as a whole, nor at entity, district and canton levels. This results in a fragmented and non-holistic approach. Implementation of existing laws and strategies related to child protection is inadequate, and not enough attention is paid to all budgetary, staffing, institutional frameworks and monitoring requirements for translating policy into action. Comprehensive information on budget allocation and utilization for child protection is scarce and requires further analysis. It is, however, evident that budget allocations are often insufficient and budget utilization inefficient in ensuring adequate quality and coverage of child protection services.
The function of preventing and protecting children and families from harm, while promoting their welfare, is not clearly defined, and is often surfacing at the margins of the overall discourse on social protection. While a lot has been done to promote an integrated approach to social protection and inclusive services at local level, the place of child protection (intended as prevention and response to violence, abuse, neglect and exploitation) had not yet been clearly defined in laws and policies.
As stated in the Situation Analysis of children in BiH, more than half the country’s population was at risk of poverty or social exclusion in 2010, with no indication that this situation has changed much since then. Children are among the most vulnerable categories: they consistently have higher poverty rates than the general population (30.6 percent in 2011 compared to 23.4 percent of the total population). The most recent Household Budget Survey conducted in 2015 did not disaggregate data on child poverty. Total social assistance benefits account for approximately 4 per cent of GDP, of which about three quarters are paid to war veterans and their families. The social exclusion of families from rural areas, Roma families and families with children with disabilities is multi-dimensional. While social and child protection legislative reforms improving the adequacy and coverage of child cash benefits have advanced in RS, the Law on Financial Support to Families with Children in FBiH was only approved in February 2020.
An important step forward in improving child welfare services has been the development of uniform, standardized case management tools for centres for social welfare (CSWs). Entity and Cantonal Ministries responsible for social welfare, together with the academia, developed Guidelines for Child Protection Case Management in both FBiH and RS in 2018. The Guidelines have been rolled out in all municipalities in RS as well as in several Cantons in FBiH. Significant improvements have also been made in establishing a sound system of foster care, with the adoption of relevant legislation and regulations, the professionalization of the social service workforce in foster care and education, and education and certification of foster parents.
Fundamental challenges to further enhancing child (and family) welfare relate to the fact that the social protection system is stretched between a “generous” (in intention) list of social benefits for vulnerable groups and responsive child protection services stepping in when there is “evidence‟ of abuse. Available services are unable or seriously restricted in their capacity to provide proactive prevention and supportive services in between the two ends of the spectrum. The services currently provided are largely limited to financial assistance, in-kind assistance, little social work services, foster care, and the institutionalization of children. To enable CSWs to provide more effective child protection, they require more human, financial, and technical resources.
The national authority is the BiH Ministry of Civil Affairs, and this ministry is in charge of defining basic principles for: coordination and consolidation of entities’ plans and definition of international strategy.
At federal level, FBiH Ministry of Health, the Department of social welfare and protection of families and children of the Ministry of Labour and Social Policy, are responsible institutions for children and youth wellbeing while in RS, the Department for social, family and child protection of the Ministry of Health and Social Welfare, is responsible for health and social security issues.
There are no state or entity youth health policy, the only available strategies currently that treats this subject are Social Inclusion Strategy in FBiH 2021-2027 and Social Inclusion Strategy in RS 2021-2027. Both of these policies deal with children and youth health and wellbeing issues, together with other aspects, and recognise importance of youth as country value.
More than half of BiH’s population was at risk of poverty or social exclusion in 2010, with no indication that this has changed much since then. Children are among the most vulnerable categories: they consistently have higher poverty rates than the general population (30.6 percent in 2011 compared to 23.4 percent of the total population). Total social assistance benefits account for approximately 4 percent of GDP, of which about three quarters are paid to war veterans and their families. Therefore, the actual expenditure on families with children, persons with non-war-related disabilities, and all other vulnerable individuals in BiH is between 1 and 1.2 percent of GDP, the lowest in the region. The social exclusion of families from rural areas, Roma families and families with children with disabilities is multi-dimensional. While social and child protection legislative reforms improving the adequacy and coverage of child cash benefits have advanced in RS, the Law on Financial Support to Families with Children in FBiH was approved in February 2020.
As stated in the Situation Analysis of Children in BiH, total health expenditure in BiH has increased significantly since 2000, to 9.3 percent of total GDP in 2016. Child health is showing signs of improvement. Despite the constitutional provisions, quality health care is not available to all, particularly to vulnerable groups, such as Roma. Fragmented service delivery, high spending on pharmaceuticals and inefficiencies in insurance and hospital systems cast doubt on the sustainability of health services. About 58 percent of health funding in BiH is allocated for inpatient hospital treatment and medical devices for outpatients, with just 1.8 percent spent on preventive health care. In 2016, out-of-pocket payments accounted for 29 percent of health spending in the country; it is likely that the poorest households forego essential health care because they cannot afford it. Health insurance entitlement is sometimes not realized among the Roma for various reasons, some of which include the lack of required documentation.
The number of medical staff compared to the overall size of the population is significantly less than the EU average; this makes adequate provision and timely access to health care services difficult. Planning and coverage of vulnerable groups remain problematic and significant exclusions persist. The varying levels of skills and expertise of health providers underpin a lack of trust between patient and medical staff and lead to variable outcomes, while the absence of uniform standards throughout the country structurally discriminates against those in rural areas.