Policy responses for Bosnia and Herzegovina - HSRM

Bosnia and Herzegovina


Policy responses for Bosnia and Herzegovina

1.5 Testing

Only people with an epidemiological link and developed symptoms can be tested (since 25 March 25th).

Testing is performed at the request of primary health care professionals. They can direct anyone who contacts them by phone and fulfil two case definition criteria (epidemiological link and symptoms) to epidemiologists. These epidemiologists interview each individual and decide who will be referred to testing according to WHO guidelines.

In Sarajevo, two cases of COVID deaths attracted a lot of public attention: a women not referred to hospital and diagnosed positively post-mortem (24 March) and a renowned epidemiologist who died in hospital (6 April) after a struggle to get tested and hospitalised, the latter described in detail in an article in the local media titled “My husband fell victim to our health system, not corona” (https://www.klix.ba/vijesti/bih/supruga-preminulog-dr-pasagica-moj-muz-je-zrtva-naseg-zdravstvenog-sistema-a-ne-koronavirusa/2004061130). This caused a lot of public stir and upset (https://www.nytimes.com/aponline/2020/04/07/world/europe/ap-eu-virus-outbreak-death-in-sarajevo.html), including claims that algorithms applied by primary care professionals for screening, testing and referral are confusing and inappropriate for a timely response of the health system. As a result, cantonal prosecution opened case investigations, and the director of Dom Zdravlja  (Primary Care Centre) of Sarajevo Canton was replaced on 8 April.

Since 10 April, an ongoing public debate on performing autopsies of COVID-19 victims was initiated: while in RS the autopsies continue to be performed (https://www.klix.ba/vijesti/bih/mogu-li-se-raditi-obdukcije-zarazenih-osoba-u-rs-u-mogu-u-ostatku-bih-ne-mogu/200409034), the Association of Pathologists and Cytopathologists of FBIH did not recommend it, especially in the local context where appropriate HG3 protection for autopsy-performing professionals cannot be secured (https://www.klix.ba/vijesti/bih/udruzenje-patologa-ne-preporucuju-se-obdukcije-umrlih-od-covida-19/200410092). After discussion with the President of the High Judicial and Prosecutorial Council of BIH, the Minister of Security of BIH requested imposing legal sanctions on those professionals who oppose performing COVID-19 autopsies (16 April) (https://bnn.ba/vijesti/radoncic-ako-patolozi-ne-pocnu-raditi-obdukcije-traziti-zakonska-rjesenja-za-sankcije). The autopsy of the first patient who had died in Sarajevo on 24 March and was confirmed SARS-CoV-2 positive was performed upon request from Sarajevo’s Chief Prosecutor at the RS Institute of Forensic medicine in Banja Luka by the end of May, two full months after the death, with results pending as of 29 May.

On 13 April, the Director of the University Clinical Centre in Sarajevo confirmed that there were around 300 health workers from the University Clinical Centre on sick leave, with about ‘two thirds of these unjustified’; when considering reports from other clinics and facilities, the media estimated that around 700 health workers in Sarajevo were absent at that moment, pending further internal investigation by the clinics. On 18 April, the MoH of Canton Sarajevo announced reorienting cantonal health facilities for the COVID-19 response from the University Clinical Centre in Sarajevo to Sarajevo General Hospital, and asked all health facilities in the canton to redistribute some of their staff toward the General Hospital, with the idea of turning it into ‘an emergency centre for COVID-19’ and thus relieving some pressure on local health facilities and the University Clinical Centre.

COVID-19 testing occurs in designated country laboratories in two cities: Banja Luka, RS, and Sarajevo, FBIH. In FBIH, two more clinical laboratories in Tuzla and Mostar have also started to perform RT-PCR tests as of the 23 March.

There are five main laboratories currently performing RT-PCR tests for COVID-19 in BIH, with some new laboratories joining the lab networks in both RS and FBIH. The Sarajevo laboratory (FBIH) has capacity to perform 552 tests a day. Testing takes between 4-5 hours on average.

On 11 May, the Public Health Institute of RS introduced commercial testing for COVID-19 in RS, priced at BAM 200. However, it was only to be offered to those who have to report back to work abroad, and for students who need to continue their studies abroad. Public health testing for case detection and surveillance purposes continues as per established protocols and free of charge for those tested.

After the information that Germany did not recognize PCR tests performed in laboratories in BIH, the authorities in BIH requested an explanation, since two laboratories from BIH undertook an external quality check with a reference laboratory in Germany (Charité Berlin) back in March (23 June). On 1 July, the BIH Ambassador to Germany confirmed that German authorities decided to accept the test results performed by BIH laboratories, with a note that their official list is being updated on a regular basis.

On 16 July, the health authorities in Sarajevo canton confirmed that they would start following WHO recommendations from 27 May on discharging COVID-19 patients from isolation without re-testing.