Overcoming challenges: implementing and scaling clinical pharmacy education and practice in the Republic of Srpska/Bosnia and Herzegovina

Abstract

Bosnia and Herzegovina, one of the six countries created from the breakup of Yugoslavia, is classified as a low resource setting despite its geographic position in Europe. It is one of the most severely affected by the Civil war and international sanctions resulting in damaged infrastructure and underdeveloped healthcare services. Clinical pharmacy, which aims to improve patient outcomes through optimized medication use, has been well established in high-income countries since the 1960s. However, in low-resource settings, its development is often delayed by inadequate education, lack of trained personnel, and limited institutional support. The main aims of this article are to present the development of clinical pharmacy services in a low-resource setting, using the example of the Republic of Srpska (an entity within Bosnia and Herzegovina), and to offer a replicable model for similar settings. This article highlights how clinical pharmacy can be gradually established through international training, structured mentorship, curriculum reform, political and institutional support. Starting in 2007 with the training of a pharmacist in the United Kingdom, the Republic of Srpska initiated a pilot clinical pharmacy service program that expanded to various hospital wards, introduced formal education programs, and integrated clinical pharmacy into daily clinical practice. Additionally, a fully reimbursed outpatient clinical pharmacy service was launched in 2023. This shows that with targeted investments and long-term strategy, countries with limited resources can establish clinical pharmacy practice. The Republic of Srpska's experience offers valuable lessons for accelerating clinical pharmacy development in other low-resource setting contexts.

Keywords: Clinical pharmacy service; Health education; Health plan implementation; Resource-limited settings.