Transcript Health Sector Reform in Trinidad and Tobago

Health Sector
Reform in Trinidad
and Tobago
Overview, Issues & Challenges.
Historical Review
 Julien
Commission, 1957
 National Advisory
council, interim
Report, 1978
 Toby
Commission Report, 1982
Health Sector Reform Program
IADB Funded
Goal of HSRP
 To
improve the health status of the
population by promoting and providing
affordable quality health care in an
efficient and equitable manner. This goal
is supported by five (5) specific
objectives:
Objectives

Strengthening the policy-making, planning and management capacity of
the health sector;
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Separating the provision of services from financing and regulatory
responsibilities;
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Shifting public expenditures and influencing the redirection of private
expenditures to high priority problems and cost-effective solutions;

Establishing new administrative and employment structures, which
encourage accountability, increase autonomy and appropriate incentives to
improve productivity and efficiency;
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Educing preventable morbidity and mortality through promoting lifestyle
changes and other social interventions.
Milestones

1989 – 1992: Eight IADB missions
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1992: Government’s decision to introduce HSR
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1993: Two teams of consultants and local counterparts established
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1994: A comprehensive Final Report with 40 Annexes prepared
outlining i) proposed models for improvements ii) human resource
requirements iii) estimated costs iv) strategy for the way forward
[National Health Services Plan]

1994: Development of White Paper and creation of the RHA Act.
Features of the NHSP
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The Plan’s strategic intent was to guide the MoH in:
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Achieving significant shifts in resources;
Reducing bed numbers;
Introducing specialist services;
Introducing new technology;
Introducing new management and operating systems;
Delivering new services based on need; and
Effectively work with provider agencies.
Critical Success Factor

The strategies embodied in the NHSP reflected
significant changes from the old order.
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A large-scale program of Technical Assistance,
that would provide the necessary institutional
strengthening support to the MoH and the
RHAs, was therefore critical to the success of
the HSRP.
Key Technical Requirements

Human Resource and Change Management Strategies
(Transition Plan);
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RHA Management Systems and Protocols;
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Quality Management;
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Need Assessment (National Disease Surveillance system);
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Health System Information Strategy
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Health Financing Strategy
Human Resource Management
Achievements
Creation of six (6) core Directorates:
• Health Services Quality
Management
• Health Policy, and Planning
•Health Promotion, and
Communication
• Finance and Projects
•Human Resources
• Information Systems
Challenges
Dual track employment (MOH and
RHA staff)
Limited capacity at RHA and MoH to
undertake new roles
RHA Management Systems
Achievements
Decentralised decision
making
Reductions in operation costs
through bulk Purchasing
Challenges
Accountability Measures such as
Business Plans, MoH Purchasing
Intentions and Annual Services
Agreements not implemented.
Health Services Quality Management
Achievements
Challenges
Report on Regulating Health Following key areas still absent:
care Quality finalised by Quality
Management Legal expert
• Risk Management Policy
Framework
Health Services Accreditation • Health Technology Assessment
Manual for T&T, approved and policy and guidelines
distributed to stakeholders
• Inventory Management and
Health Services Quality Council • Review of Medical Record
operational
Policy and Procedures
Health Needs Assessment
Achievements
Challenges
Baseline Assessment (Situation First nationwide HNA not yet
Analysis) Completed
done
Health Information Systems
Achievement
Information Technology
Strategic Pan including
Hardware and software
procurement requirements
developed. IT strategic Plan
revised within last 6 months
Challenges
Original consultancy was not of
the required standard and was
aborted
Delays in attracting a new
National IT Director
The Public sector’s Information
backbone (platform) not yet
available
Health Financing
Achievements
Challenges
New Technical Secretariat to Numerous aborted attempts at
spearhead alternative financing new financing strategies have led
for the sector implemented to stakeholders’ scepticism
within last year
Conclusion
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HSR objectives were on target.
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HSRP design for achieving health system improvement
was sound
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The soft components (technical know how) to effect
the sector’s full transformation lagged because among
other things:
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The general Public Sector Reform process was slow
There was limited absorptive capacity at the MoH and RHAs