Conflict of interest in health care: Until noon, the deputy, from noon, the director, then submits a report to himself

According to the current legislation, directors of health institutions who are also candidates can continue to perform their functions without interruption. And they use it abundantly

Written by: Rubina ČENGIĆ

– If I enter the Sarajevo Canton Assembly, it will be very interesting. You will have to watch every assembly. Yes, it will be a spectacle, for sure – Sebija Izetbegović, SDA candidate for the Sarajevo Canton Assembly and director of the Sarajevo University Clinical Center, said at a pre-election rally.

No one, not even the member of the Board of Directors of the Clinical Center of the University of Sarajevo (KCUS) Lejla Brčić, knows whether Dr Izetbegović coordinated her professional obligations with the election campaign.

I'm never on vacation, Sebija Izetbegović told us
I’m never on vacation, Sebija Izetbegović told us

– It is an official campaign that is problematic in itself, but it is not a conflict of interest, for which no one normally reports anyone in our country. If she were to be elected and remain in the position of director – then it would be a conflict of interest because we submit the report to the Sarajevo Canton Assembly as one of our founders – says Brčić.

To the written inquiry of the KCUS director’s Cabinet about whether Izetbegović took annual leave during the campaign or if there is a schedule for her leaving work – there was no answer.

I’m never on vacation

Only in one chance encounter on the streets of Sarajevo, during a meeting with citizens, does Izetbegović recognize the journalist who sent the inquiry and addresses her from one side of the street to the other.

– Are you asking if I took annual leave? I did not. I’m never on vacation. Now I’m here with people, and then I’m going back to the Clinic – she said.

Sebija Izetbegović is the wife of Bakir Izetbegović, president of the SDA, member of the Collegium of the House of Peoples of the BiH Parliament, a former member, and in these elections, a candidate for the Presidency of BiH.

It was during his first mandate that she was appointed as the director of KCUS, whose founders are the Federation of BiH and five cantons.

According to the Law on Conflict of Interest in Bosnia and Herzegovina – a member of the Presidency of Bosnia and Herzegovina and a delegate of the House of Peoples of the Parliamentary Assembly of Bosnia and Herzegovina, in this particular case Bakir Izetbegović is an “elected official”, Sebija Izetbegović is his wife and in accordance with that law is his “close relative”, and the director of the institution was appointed as the director of KCUS, but at the FBiH level and the Law on Conflict of Interest in BiH does not recognize this relationship as a conflict of interest.

In addition, although the House of Peoples of the FBiH Parliament elects and appoints delegates to the House of Peoples of the BiH Parliamentary Assembly, and Sebija Izetbegović was a member of the House of Representatives of the FBiH Parliament when Bakir Izetbegović was appointed to the House of Peoples of the BiH Parliament. But according to the Law, this is not a conflict of interest either.

Founder and co-owner of the hospital

At the state level, a delegate in the House of Peoples of the BiH Parliamentary Assembly is also in a conflict of interest not recognized by law, Lazar Prodanović from SNSD, founder and co-owner of the hospital St. Nikola in Milići.

He is also a member of the Expert Council of the Agency for Medicines in BiH, which is the Agency’s expert, regulatory, advisory, and control body.

Prodanović: He did not sign the statement
Prodanović: He did not sign the statement

For the sake of clarification – the BiH Parliament passes legal decisions on the work of this agency and adopts the budget of BiH, from which the Agency is also financed.

According to the Law on Medicines in BiH “The Expert Council of the Agency is appointed by the Council of Ministers of BiH from among prominent experts in the fields of pharmacy, medicine, chemistry and law from both entities and Brčko District of Bosnia and Herzegovina, on the proposal of the Ministry of Civil Affairs of BiH from the list of candidates established by the entity ministries of Health and the Department of Health of Brčko District, and the Expert Council is responsible, among other things, for considering and directing the implementation of the guidelines of the authorized ministries on the policy on drugs and medical devices”, including the guidelines of the Ministry of Health in the RS Government.

Otherwise, the members of the Expert Council are required to sign a statement on the absence of conflict of interest, which was not done in this case, even though Prodanović, according to the Law on Conflict of Interest in BiH, is at the same time an “elected and appointed” official at the same level of government. According to available information – although he is not a candidate in the 2022 elections, he is a candidate for a delegate in the House of Peoples of the PS BiH.

If not, it will be after the election

A large number of political parties entered the election campaign with candidate lists on which are health workers who are in conflict of interest or will be if they are elected because they are directors of health institutions, members or presidents of management boards and the like, that is, they are in places where they submit work reports or approve their own budgets, which can lead to abuse of influence or power in hiring and appointment, but also to unequal distribution of money for public health institutions.

On the other hand – the availability of information is also a problem: directors are appointed by management boards, and members of management boards are appointed by parliaments or assemblies, municipal and city councils, depending on the level of authority of the founder of the health institution, and their names are rarely available to the public on the websites of health institutions.

The director of the Banjaluka Health Center and member of the Banjaluka City Council, Nevena Todorović, is also in the campaign – she is the SNSD candidate for the RS National Assembly.

Since the beginning of the campaign, she has been visiting local clinics and handing out plaques and certificates of appreciation to deserving workers, which she publishes on the website of the Home (Dom zdravlja – JZU Dom Zdravlja, Banja Luka (domzdravljabanjaluka.com)), but her associates in charge of public relations are not at thie work places – their colleagues explain that they are “in the field and filming something”.

The director of DZ Banja Luka (second from the left) announces party activities on the official website of the Health Center
The director of DZ Banja Luka (second from the left) announces party activities on the official website of the Health Center

For the past four years, she was in a conflict of interest because, as the director of the Health Center, she submitted a report to the Assembly of the City of Banjaluka, of which she is a member, and therefore to herself. If she is elected for the NSRS, reports will be submitted to her by personnel from her party who are directors of health institutions at the level of Republika Srpska.

The President of the Board of Directors of the Banjaluka Health Center, Aleksandar Božić, promises to “get back to you later” at our invitation. She didnt, because there is no real explanation for the actions of colleague Todorović.

Member of the Assembly of the City of Banjaluka, Milko Grmuša, says that the problem is “that the candidates if elected, remain in high positions in healthcare, and the commissions for conflict of interest do not do their job”.

– It seems to me that the parties especially push doctors onto the lists, probably because they have contact with many people. I think that they can go to the elections and participate in the campaigns, but if they are elected, they would have to leave their positions in the health sector. A special problem is the business reports that they end up submitting to themselves. On the other hand, if they are only doctors and members of parliament – that is still acceptable, but being a director and a member of parliament at the same time opens up space for abuses, political influence, use of benefits… If you draw attention to it – you will immediately be accused of politicking, and when you go at the doctors – they are not there because they are running a campaign or politics – says Grmuša.

And in the campaign for the Assembly of the Una-Sana Canton, there is a representative in that assembly, Amir Murić from DF, who is also the director of the Public Institution Dom zdravlja Cazin.

Since the Health Center is a cantonal institution, Murić submits a report on his work to himself even if he is elected to the Assembly of the Una-Sana Canton. It will continue to do so.

Murić: Representative and director
Murić: Representative and director

Otherwise, the director is appointed by the Board of Directors, whose members are appointed and dismissed by the Government of the Una-Sana Canton on the proposal of the Minister of Health, Labor and Social Policy.

During the pre-election campaign, on the website of the Cazin Health Center, it was reported that the Health Center received new vehicles, which were purchased for them by the USK Government for 300,000 KM. Cantonal Prime Minister Mustafa Ružnić, who is the current holder of the NES list for that canton, took part in the handover.

And this, according to the amendments to the Electoral Law announced by the high representative in BiH in August 2022, is a misuse of public funds because the procurement of cars of this value is not foreseen in the public procurement plan of the Una-Sana Canton Government. The purchase of two cars with a total value of 98,000 KM is planned (https://vladausk.ba/v4/files/media/pdf/62399b76ea4411.63454557_ Plan%20javnih%20nabavki%20za%202022.%20godinu.pdf from February 2022 and https://vladausk.ba/v4/files/media/pdf/62692784384ea5.52599500_ Izmjena%20Plana%20javnih%20nabavki%20za%202022 .%20godinu.pdf from April 20, 2022.)

Among the candidates is Ivan Ivić from HNP (Croatian National Movement), who was previously in HDZ BiH. He is a delegate in the House of Peoples of the FBiH Parliament, a representative in the Assembly of Canton 10 and the director of the Public Institution Dom zdravlja Odžak, which, according to available data, is a cantonal health institution.

All this means that Ivić now submits a report on his work at the Health Center to the Assembly of which he is a member, and if he is re-elected to the cantonal Assembly, this practice will be continued. This is a conflict of interest that the laws in BiH do not recognize.

The law is not upheld

Srđan Traljić from Transparency International in BiH explains that according to the current legislation, directors of health institutions who are also candidates can continue to perform their functions without hindrance.

– Laws on conflict of interest in FBiH and at the state level consider directors of public institutions as holders of executive functions. This practically means that at the same time they cannot be in the management of public companies, they cannot have private companies that do business with the state, they cannot be at the head of associations that are financed from the budget, but they can still perform several executive functions, for example being deputies and directors institutes. An additional problem is that this law has not been applied at all in the FBiH since 2013, and most health institutions are at the entity and local level to which this law applies – explains Traljić.

He emphasizes that such an attitude towards the conflict of interest in healthcare leads to real problems.

– Transparency International in Bosnia and Herzegovina is advocating for the improvement of the law on conflict of interest at all levels in order to prohibit it, however, we currently have different practices. In Republika Srpska, the restrictions in the Law on Conflict of Interest do not apply to directors of public institutions, and in one article it is even explicitly stated that elected representatives, holders of executive functions and advisors can perform duties in cultural, health and sports institutions, in associations and the like for what I can receive a salary. Practice shows that a large number of MPs and councillors are at the head of these institutions, and TI BIH has been warning for years about the abuse of public resources for pre-election purposes – says Traljić.

Traljić: Such an attitude towards the conflict of interest in healthcare leads to real problems
Traljić: Such an attitude towards the conflict of interest in healthcare leads to real problems

He also reminds that a large number of deputies and councillors are at the head of health and other public institutions and public companies.

Patients also voted

– They use the resources of these institutions for the election campaign and vote collection, both through employment and other privileges. Take, for example, the RS University Clinical Center – the director is a member of parliament and the president of the city committee of the party. For the last general elections, they had a paid campaign “All under one roof”, which promoted the candidates in the elections. Patients from the health records were also invited to vote for the director who was a candidate. For this and a number of other reasons, it is important to depoliticize both institutions and public enterprises – emphasizes Traljić.

Traljić also reminds that in this particular case, the TI BiH reported the case of voting for the director to the prosecution, that the prosecution investigated the case and determined that the calls came from the official phones of UKC RS. However, the investigation was suspended with the explanation that the phone number of those who were invited to vote is not personal information and that it is not abuse, although the position of official institutions is different.

And that it can be done differently is shown by the example from Lukavac.

Dajana Čolić from DF is campaigning for the Parliament of the Federation of Bosnia and Herzegovina. She was the director of the JZU Dom zdravlja Lukavac, whose founder is the Lukavac Municipal Council and the council in the Lukavac OV. She resigned from the position of director when she was appointed to the Tuzla Canton Government.

– She was a counsellor and director of the Health Center, and I believe that this is a conflict of interest. When the cantonal government in which she was a minister collapsed, she was a candidate for director, but did not pass. If she was still a director and a candidate – that would be a conflict of interest, and if she is now elected to the FBiH Parliament, she can only return to the Health Center as a children’s dentist, which is her specialization – says Edin Delić, mayor of Lukavac.

He believes that doctors in politics are a big problem because they introduce politics into health institutions, which is not good.

Maybe it’s up to the founder? Or to the Law, which has been a dead letter on paper for a long time? And a clear signal that changes are needed.

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Naredna vijest

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