Financial sustainability strategies of public primary health care centres in the Republic of Srpska, Bosnia and Herzegovina

Abstract

Background: The literature on the functioning of public health facilities in health systems with significant arrears is limited. The growing liabilities of health facilities and the accumulating arrears have been a challenge in the Republic of Srpska. Most public primary healthcare (PHC) centres generated a gross loss in 2018. Method: Guided by the 'positive deviance' approach, we used an exploratory case study design to identify strategies used by managers to achieve financial sustainability in eight top-performing PHC centres. Qualitative data were collected through face-to-face in-depth semistructured interviews with key informants from the PHC centres that reported positive financial results in 2018. Results: Seven organisational goals, comprising 34 financial sustainability strategies, were recognised during the data analysis and were used to build an organisational-level model for a PHC centre. Conclusion: Managers concurrently used multiple strategies to ensure financial sustainability. Each centre tailored its range of strategies to the organisational context, local context, and wider environment of the health system. The strategies were conceived and implemented by managers operating at different organisational levels under the leadership of top-level managers. Managers of indebted health facilities can learn from the positively deviant peers who manage facilities that achieved satisfactory financial performance.

Strategies for improving the financing of family medicine program: Evidence from Iran

“…The findings reveal that successfully implementing the FM program requires revising and improving resource identification, resource pooling, service delivery methods, payment system models, implementation processes, and management structures within PHC financing. Health financing policies play a crucial role in achieving UHC, and each country's progress toward this goal is influenced by its healthcare financing methods 28,29 . The financial arrangements within health service delivery systems greatly impact the delivery of PHC, encompassing the funding received, fund transfer methods, and incentives provided for payment to healthcare providers 6 …”

“…Health financing policies play a crucial role in achieving UHC, and each country's progress toward this goal is influenced by its healthcare financing methods. 28,29 The financial arrangements within health service delivery systems greatly impact the delivery of PHC, encompassing the funding received, fund transfer methods, and incentives provided for payment to healthcare providers. 6 Moghaddam et al identified challenges in the FM program, including insufficient overall financial resources, unstable funding, and a lack of coherence in the management of the financing system system.…”

“…Health financing policies play a crucial role in achieving UHC, and each country's progress toward this goal is influenced by its healthcare financing methods. 28 , 29 The financial arrangements within health service delivery systems greatly impact the delivery of PHC, encompassing the funding received, fund transfer methods, and incentives provided for payment to healthcare providers. 6 …”