Eastern Caribbean Health Systems Assessment


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Lisa Tarantino, Health Systems 20/20

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  • For example, procurement of pharma is regional – we didn’t go into depth
  • Special emphasis on the private sector – in each building block of the system, what is its role? How can it be better leveraged? Need to look at all actors, all resources, all sources of funding. Note that this is an example of using a donor’s HIV/AIDS priority to strengthen entire system.
  • No system for quality assurance of health services Quality tracked internally at MSJMC, but no oversight by MOH No systematic quality improvement process at primary level Efficiency of service delivery not optimal Over reliance on MSJMC for minor health issues Centralized HIV/AIDS treatment Gaps in patient referral process Informal referrals and limited follow-up within the public sector Limited referrals between private and public sector Insufficient health promotion and education Minimal referrals between private and public sector Some referrals between public and private facilities/labs exist (e.g. for FP) but more can be done to optimize health outcomes MSJMC now initiating process of follow-up of referred patients who continue treatment at PHC in collaboration with the Community Nursing Services Quality of care issues Indicators on QA tracked internally at MSJMC, but no oversight by MOH/govt. Unclear how quality of care for some services is monitored at PHC (notably for NCDs) No formal referral process and follow-up within the public sector HR and Pharma issues here?
  • Staff and technology at MOH (e.g. Health Information Div) Integrated information system now built at MSJMC Computerized HIS for HIV/AIDS treatment New system for mental health – annual report of incidence and type) in use at the hospital and data kept at HIS Adequate physical resources at HID: 5 data management staff, each with a computer, internet access; workload for this team: the RHIS consists of 2 weekly surveillance reports (one form MSJMC and one form community health services), and 8 districts submitting about 5 reports monthly on service utilization (ANC & PNC report, Child Health Report, Adult Health Report, etc.) about 50 births to be entered in births database deaths to be entered in deaths database Initiative by Statistics Division to provide technical assistance to line ministries but this is likely to only affect the data that they need, an unlikely to happen this year due to Census Data collection and reporting process at primary health care facilities is functioning Surveillance system in the public sector
  • Sufficient pharmaceutical human resources, facilities (pharmacies, wholesalers, distributors, etc.) Legal framework developed Good access to quality pharmaceuticals Collaborative relationship with PPS in procuring and monitoring pharmaceuticals Existence of national and regional training programs Adequate financial resources for procurement (beurocracy in accessing,
  • No financial dimension to planning.  MBS does not show in Government budget. Growing burden of chronic disease (requires more patient educ, more collab with secondary care etc) Will drive increasing demand for costly interventions (example: dialysis) Insurance – this is effectively leveraging of the private health sector
  • Eastern Caribbean Health Systems Assessment

    1. 1. Eastern Caribbean CountriesHealth Systems and Private Sector Assessments 2011 Lisa Tarantino Antigua and Barbuda Assessment Team Abt Associates, Inc. April 24, 2012
    2. 2. 7 Countries Assessed 1. Antigua and Barbuda 2. Barbados 3. Dominica 4. Grenada 5. St. Kitts and Nevis 6. St. Lucia 7. St. Vincent and the Grenadines 2
    3. 3. Objectives  Improve sustainability of systems and HIV/AIDS programming in view of diminishing donor funding (PEPFAR funded)  An overview of the entire health sector organized around the six HSS building blocks  A description of pressing health issues and priority system challenges  A summary of private sector contributions to health  Actionable recommendations to strengthen health system and leverage private health sector  Develop action plans for addressing priority recommendations 3
    4. 4. Guiding Principles Holistic view of the health system – comprised of public, private (for-profit) and NGO/FBO elements Collaborative, high level of engagement with partners and stakeholders: MOHs, private sector, USAID, PAHO, NGOs, etc. Given declining vertical funding for HIV/AIDS, need for integration into existing health systems and services Recommendation criteria:  Contributes to the sustainability of the health system  System focused and addresses key performance criteria  Equity, Access, Quality, Efficiency, Sustainability  Feasible in short term, essential in long term 4
    6. 6. Governance and LeadershipStrengths and Opportunities Weaknesses and ThreatsPHC level is well managed Government budget constraintsMOH works with professional Inadequate reporting impactscouncils, which are active accountability (CBH, MSJMC, MOH)Media has a public information MOH needs human resources forservice and a watchdog function planning and developing regulationsNeighboring country laws and Inadequate strategic planningregulations can be easily adapted Significant gaps in legislation andInternational guidelines used for regulation of the health sectorenvironmental health & sanitation Some infrastructure investment neededPublic sector reform may impact (MOH)health sector positively 6
    7. 7. Human Resources for HealthStrengths and Opportunities Weaknesses and ThreatsHigh levels of competence and Lack of a comprehensive HRH policydedication exist Absence planning mechanism in MOHAdequate number of health workers Ad-hoc transfers of personnel results inacross most cadres & specializations loss of capacity, mismatch of personnel and needs of institutions, demotivationScholarships to support training Established/Non-Established disparitiesHealth training services exist, eg nursing impacting moraleschool, relevant faculties of UWI to Limited personnel and services in dentalsupport pre and in-service training psychiatric/mental health, rehabilitation(MSJMC internship program) Pharmacy school viabilityPublic Sector Modernization presents Limited supervisory and appraisalopportunity to address anomalies in staff capacity in primary health caredesignations & conditions of employment 7
    8. 8. Service DeliveryStrengths and Opportunities Weaknesses and ThreatsStrong primary care, particularly for No system for quality assurance ofinfectious diseases, maternal and child health serviceshealth Efficiency of service delivery notAdequate number of facilities, optimaldistributed evenly across the country  Over reliance on MSJMC for(both public and private), new hospital minor health issuesMost specialized tertiary care available  Centralized HIV/AIDS treatmentin-country  Gaps in patient referral processInfrastructure and education/literacy of Insufficient health promotion andthe population education
    9. 9. Health Information SystemsStrengths and Opportunities Weaknesses and ThreatsAdequate physical resources for HIS Fragmentation of the HIS:in the public sector  Routine data from MSJMC isEstablished routine data collection and not collected by MOH (exceptreporting process at primary health care for surveillance)facilities  Private facilities not part of theEstablished surveillance system system  Separate data collection and processing systems for different types of HIV/AIDS data Efficiency of data management at central level Inadequate use of data for planning
    10. 10. Pharmaceuticals & Medical ProductsStrengths and Opportunities Weaknesses and ThreatsSufficient pharmaceutical human Weak regulatory frameworkresources, facilities Insufficient monitoring/regulation ofGood access to quality facilities and pharmaceuticals, especiallypharmaceuticals in the private sectorCollaborative relationship with PPS in Inadequate Pharmaceutical MIS/dataprocuring and monitoring for decision makingpharmaceuticals Inadequate pharmaceutical management coordinationExistence of national and regional Absence of Standard Operatingtraining programs ProceduresAdequate financial resources for Lack of standard treatment protocolsprocurement Inconsistent pharmacovigilence practices
    11. 11. Health FinancingStrengths and Opportunities Weaknesses and Threats7% payroll tax (with no ceiling salary) Lack of available data on what existingcommitted to health care service commitments really cost orPublic services available without projections on funding growth in future.significant financial barriers Fragmented financing: No good data on total public health expenditure.15-20% of population has private Growing burden of chronic disease,insurance (about 15,000 people) where primary health system is weakest.Not a huge need for major capital There is a danger that tertiary careinvestment (MSJMC) commitments will erode the primary care system. 11
    13. 13. St. Lucia, Antigua and Barbuda, Dominica 1. Prepare population and leadership for the fact that system is not currently sustainable, and build political will for change (Antigua and Barbuda) 2. Invest in financial analysis (costing, NHA) and strategic planning 3. Prioritize updates and passage of key legislation and gazette regulations to enforce enacted laws 4. Improve efficiency and quality at all levels of care (strengthen referral system, collect and use data from hospital, private sector) 5. Pursue opportunities to engage the private sector as a partner 13
    14. 14. Next steps – Action! 1. Dissemination and validation workshops resulted in:  Prioritization of recommendations by public and private sector stakeholders  Action steps discussed, negotiated and agreed 2. Commitments by development partners to consider prioritized recommendations and plans 3. Technical support sought and accessed from USAID (and others) 4. Technical support initiated in areas of health financing strengthening (costing) and private sector mapping 14
    15. 15. Thank you! Lisa TarantinoAntigua and Barbuda Assessment Team Abt Associates, Inc. April 24, 2012