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

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.