Objective: Prior to national independence there was no center for advanced treatment of cardiovascular disease in Bosnia. A high percentage of the health care budget of the republic was used to pay for such services in other republics and abroad. The purpose of this paper is to describe the methods used to develop a modern, national treatment canter in Tuzla. Methods: The war of aggression against Bosnia forced the health care personnel to re-evaluate the organisation. At the end of war heart disease soon reemerged as the major cause of mortality and morbidity. An effort was started in Tuzla to develop a modern center based on new principles.

a) An exchange program was started to educate health care personnel locally and international centers.

b) An intensive English language program was started to facilitate communication and make modern teaching material available to the team

c) The Tuzla medical leadership encouraged a reorganisation and decentralisation of decision-making processes.

d) Extensive travel and consultation programs were conducted through a grant program supported by USAID.

e) Building upgrades and equipment purchases were accomplished by international and local funding.

f) International supervisor was established with clear goal that the local team would be self-sufficient in a short time period.

g) Corporation with the University was established to initiate and research efforts.

h) The insurance funds took an active role in establishing modern reimbursement policies.

Results: The Tuzla cardiac program is presently very active. All modern therapies for coronary artery valvular disease are established. A center for pacing and electrophysiology will be opened this year. The academic program is being established and will bring new resources and programs to Bosnia. Huge savings for the society in the form of spared lives and finances are being realised. Conclusion: We believe that a partially independent Center model had shown great promise in the Tuzla Cardiovascular Center. We believe that this model can be applied to most tertiary care services in the country. The medical care system in Bosnia must be based on financial independence and responsibility, excellent quality of care and freedom of choice for the population. We believe that the cardiovascular center in Tuzla can serve as a model to accomplish such goals.

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