Bosnia and Herzegovina

Go directly to legislation of specific CAM therapies in Bosnia and Herzegovina:
Acupuncture – Anthroposophic medicine – Ayurveda – Chiropractic – Herbal medicine/Phytotherapy – Homeopathy – Massage – Naprapathy – Naturopathy – Neural therapy – Osteopathy – Traditional Chinese Medicine (TCM) – Other treatments

Bosnia and Herzegovina is listed as a potential candidate for European Union membership (52) and has been a member of the Council of Europe since 2002 (12).

Following the dissolution of former Yugoslavia the Dayton Peace Agreement (DPA) ended a 1992-1995 war, and established Bosnia and Herzegovina (BiH) as a state consisting of two entities: Federation of Bosnia and Herzegovina (FBiH) and Republika Srpska (RS), and later the Brcko District (BD). The Federation of BiH consists of ten Cantons, each of them with its own administration.

Under the DPA constitutional construction BiH is a sovereign state with a decentralized
political and administrative structure, where the responsibility for social policy, health and education is allocated to the level of entities and BD. In practice, the social sector is
organized in three (3) distinct systems with ten subsystems in FBiH. Since 2003, there has been a loose coordination mechanism, among others in the areas of health, social policy and education, established at the state level within the Ministry of Civil Affairs.

The legal and regulatory status of CAM and CAM practices

There is no general CAM law neither at the state level of Bosnia and Herzegovina or the
levels of Federation BiH, Republika Srpska or Brcko district. However, recent laws on health care both in Federation BiH and Republika Srpska, have introduced CAM for the first time.

In BIH, graduate and postgraduate education of doctors, dentists and pharmacists is organized by the relevant ministries for education, and held at five faculties of medicine (Universities of Sarajevo, Tuzla, Mostar, Banja Luka, Istočno Sarajevo), three faculties of dentistry (Sarajevo, Banja Luka and Istočno Sarajevo), and three faculties of pharmacy(Sarajevo, Banja Luka and Tuzla).

The curricula and syllabi for medicine and dentistry are designed to cover 6 years of study, including both theoretical and practical courses. The faculty of pharmacy provides a 5-year education for undergraduates. Upon completion of the full training course, there is a mandatory 1-year residency (registration course) for newly graduated general practitioners (GPs) and dentists, mostly at the primary health care level.

Such “residents” are expected to take the professional state examination, whereby they are then authorized to perform medical duties independently as licensed GPs, or to continue with a specialization training program in a particular field of medicine/ dentistry/ pharmacy. Specialized training programs take 3–5 years, depending on the professional branch (53).

Republika Srpska

Law on Health Care (Official Gazette of the RS, No 106/2009 (54), Article 121):
(1) Alternative Medicine, in terms of this Act, includes traditional and alternative methods and procedures for diagnosis, treatment and rehabilitation (hereinafter referred to as alternative medicine), which beneficially affect or might have a beneficial impact on human health or the health condition and that in accordance with a valid medical doctrine are not covered by health services.

(2) The minister shall prescribe the methods, procedures, and approval for the performance of alternative medicine in paragraph 1 of this article in the medical institutions.

Additionally, a draft of a bylaw currently under preparation, envisages that only health professionals with a university degree education and with licence issued by responsible chambers will be allowed to practise CAM in the RS.

Health professionals with so-called secondary degree education (nurses, physiotherapists and midwifes) will be allowed to practise CAM if they possess a valid diploma as well as a licence issued by a responsible chamber (5).

The following CAM methods will be covered in this bylaw: ayurveda,
acupuncture, traditional Chinese medicine, homeopathy, phytotherapy, quantum
medicine, chiropractic, macrobiotics, traditional domestic medicine, apitherapy,
aromatherapy, qigong, reiki, yoga and t’ai chi ch’uan.

Federation of Bosnia and Herzegovina (BiH)

Law on Health Care of Federation BiH (Official Gazette of FBiH. No. 46/10) (55), Article 46: “Alternative medicine, in terms of this Act, include those proven and by experts not
forbidden complementary and alternative methods and procedures for diagnosis, treatment and rehabilitation (hereinafter referred to as alternative medicine), which has a beneficial impact or which could have a beneficial impact on human health or the health status and which, in accordance with a valid medical doctrine are not covered by health services.

Methods and procedures of alternative medicine in paragraph 1 of this article, can only be introduced in a medical institution or private practice with the consent of the competent Cantonal Ministries of health (hereinafter: Cantonal Ministry) and the relevant chamber. Methods and procedures of alternative medicine cannot be implemented at the expense of the compulsory health insurance” (53).

Law on Health Care of Federation BiH (Official Gazette of FBiH. No. 46/10) (3), Article 47: “Allowed are only those methods and procedures of alternative medicine that:

1) Have no adverse health effects.
2) The user – the patient does not distract from the use of valuable health care services.
3) Are performed in accordance with recognized standards of alternative medicine.

Methods and procedures of alternative medicine can be performed only by health workers who have permission to perform the methods and procedures of alternative medicine issued by the Cantonal Ministry. Further conditions, manner and procedure of the methods and procedures of alternative medicine in a medical institution, or private practice will be regulated in bylaws introduced by Federal Minister.

Cantonal Ministry supervises the performance of the methods and practices of alternative medicine in institutions or private practice, in accordance with the law. Provisions of this legislation apply to health care workers who perform the procedures and methods of alternative medicine, on the issue, renewal and revocation of licences for independent work (hereinafter licence)”(53).

Law on Health Care of Federation BiH (Official Gazette of FBiH. No. 46/10) (3), Article 48: “For his work, health care workers who perform the methods and practices of alternative medicine bear experts, ethical, criminal and material responsibility.

According to this law, relevant bylaws envisaged in the Art 47 will be adopted within 18
months of the law enforcement date (August 2011)”(53).

Brcko district of BiH

Law on Health Protection of Brcko District BiH (Official Gazette BD 2/01)(56).
-no provisions on CAM (53).

The governmental supervision of CAM Practices

In Federation BiH, supervision of the professional work of medical institutions, health
workers, and private health workers is carried out by competent authorities for inspection: the Federal and Cantonal Health Inspectors.

Federal health inspectors perform health inspections in health care institutions founded or co-founded by the Federation, and cantonal health inspectors do the same in the health care institutions founded by the canton or the natural (human being) or legal person, as well as private practice.

In cantons which have not established cantonal health inspection, health and work
inspection may be performed by federal health inspectors in accordance with the special
Law on inspections of the FBiH.

In case of technical failure made by health workers, or violations of the ethics and medical deontology, the competent health inspector will defer the subject to the action of the local Chamber (53).

In Republika Srpska supervision is regulated through Law on General Inspectorate and its regular day-to-day implementation. The General Inspectorate deals with any kind of
inspectorate job in the RS including the health sector. In practice, health professionals who practise CAM are supposed to carry out their patient treatment in accordance with
requirements of the above-mentioned bylaw (bylaw about space, equipment and
personnel) (57).

The reimbursement status of CAM practices and medicinal products

In Republika Srpska, reimbursement of CAM practices is not regulated by law, and hence not covered by the obligatory health insurance scheme (57).

In Federation BiH, CAM reimbursement is regulated; the Law on Health Protection, art 46, para 3: “Methods and procedures of alternative medicine cannot be implemented at the expense of the compulsory health insurance” (53).