Political Analysis of Health Reform in the Dominican Republic
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Political Analysis of Health Reform in the Dominican Republic



Report to be presented in my Health Policy class for my Masters in health Social Science

Report to be presented in my Health Policy class for my Masters in health Social Science



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    Political Analysis of Health Reform in the Dominican Republic Political Analysis of Health Reform in the Dominican Republic Presentation Transcript

    • Political Analysis of Health Reform in the Dominican Republic Glassman, A., Reich, M., Laserson, K., and Rojas, F. Presented by B.E. Nillos MAHESOS
    • Introduction • Latin America in the 90’s initiated Health Sector Reform • Little attention on political challenges associated with health sector reform • Reform = profoundly a political process that affects the allocation of resources in society, and often imposes significant costs on well, organized, politically powerful groups.
    • Health Sector Reform • Activities undertaken cooperatively between the international development banks and a national government to alter in fundamental ways the nation’s health financing and health provision policies. • Definition is limited to the interaction between international lending agencies and national government bodies.
    • Health Sector Reform • Primary Goal = self-sustaining national health care financing system • Secondary Goal = greater coverage for basic health services at a lower cost per person, rationalized decision-making within public sector health agencies, institutional reform, expand access for disadvantaged populations
    • Political Analysis = Framework for Analysis* 1. Define the content of the policy under consideration 2. Identify political players, their interests and relationships 3. Analyze opportunities and obstacles to the policy 4. Design political strategies 5. Assess the potential and actual impacts of proposed strategies
    • Health Reform in the Dominican Republic: Attempts • “modernization” of the health system (UNDP) – no follow-on activities • Introduced “National Health Law” – not pushed through • Creation of National Health Commission (CNS) and Office of Technical Coordination (OCT) – drafted “white paper”, became basis for reform proposal and is the focus of the analysis
    • Political Environment of the Dominican Republic • 1988 – third lowest GDP per capita in the Americas • Limited pluralist system without accountability, without an explicit political idealogy • Most decisions were taken by the President personally (Joaquin Balaguer). • SESPAS is major health service provider but Secretariat of the President is significant source of financing
    • Analysis of the OCT Reform Proposal (White Paper) • Policy Content: ▫ Principles: universal access, equity, solidarity, quality, freedom of choice, efficiency, efficacy and transparency ▫ Strategic Guidelines: design of single system, shift to preventive services, strengthened regulatory role of state, increased financing, guaranteed benefits for affiliates, efficient systems and social participation ▫ Policy Mechanisms: new model, decentralization, role transformation and competition.
    • Analysis of the OCT Reform Proposal • Players ▫ Public Sector: SESPAS (High Power, Low support), IDSS (Medium power, low opposition) ▫ Private Sector: highly opposed to regulation (moderately opposed, high power) ▫ Unions: AMD (High power, highly opposed) ▫ Political Parties: Leonel Fernandez, PLD (High Power, Low Support) ▫ NGO’s: (Low power, Low opposition)
    • Analysis of the OCT Reform Proposal • Opportunities and Obstacles: ▫ OCT has ample financial resources, but limited staff ▫ Broad consensus that health system has multiple problems and needed serious improvement.
    • Analysis of the OCT Reform Proposal • Strategies: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Create common ground Create a common vision Define the decision-making process Mobilize and prepare key actors Initiate pilot studies Political parties/new government Initiate strategic communications SESPAS and IDSS: manage bureaucracy Strengthen Alliances with Int’l organizations Involve “Friends” in the Planning AMD and IDSS: Create strategic alliances
    • Conclusions • Factors that affect pace and feasibility of Health Sector Reform Proposals 1. Leadership of the reform 2. Political strategies adopted by the reform group 3. Location of the reform group 4. Ownership of the reform 5. Political language of reform 6. Political timing of the reform
    • END “Politics is medicine in a large scale” - R. Virchow