Transcript Mental Health Development in Latin America & Carribean

HEALTH CARE DEVELOPMENT IN
LATIN AMERICA & CARIBBEAN
COUNTRIES
Focus: DOMINICAN REPUBLIC
Y. Reyes
Columbia University School of Social Work
April 11, 2011
LATIN AMERICAN & CARIBBEAN HEALTH TRENDS
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Tug between the role of government and the role of nonstatutory welfare
institutions in providing care
Are taking a progressive agenda in the development of social welfare
Nonstatutory welfare institutions have in essence been forced to be key
service providers (Midgley, 1997)
New initiative: producing health outcomes as stated in the United Nations
Millennium Development Goals
Takes on a reconstructionists approach, which is highlighted in many
welfare pluralists states (Midgley, 1997; Mkandwire, 2007)
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Government has involvement but rebuilding of welfare states should accept
increased privatization and some budgetary reduction of expenditures (Midgle,
1997; Figuiera, 2002)
Research Study
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Descriptive research study design, non probability sampling method
90 day study in mental health needs of a clinic in Monte Plata,
Dominican Republic
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Patient observations in the HIV/AIDS clinic
Interview of medical and administration teams
In-depth interviews with the following organizations:
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Fundación Global Democracia y Desarrollo (FUNGLODE) and Global
Foundation for Democracy and Development (GFDD)
Colegio Dominicano de Psícologos (Dominican College of
Psychology)
Universidad Iberoamericana (Iberoamericana University)
Colegio Medico Dominicano (Dominican College of Medicine)
Instituto Nacional de la Salud (National Institute of Health)
Batey Relief Alliance (BRA) Dominicana
Presidential Public Health Advisor, Dr. Alberto Fiallo
DOMINICAN REPUBLIC
INTERNATIONAL HUMAN DEVELOPMENT INDICATORS - UNDP
DOMINICAN REPUBLIC HEALTH MODEL
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Transitionary period to separate functions and decentralize services (2007)
Modeled after Chilean Health Model
2007 review, PanAmerican Health Organization (PAHO)
showing strides with regards to providing coverage to its' population (18%)
 general health law no. 42-01 and the social security system law no. 87-01 have been
created which establish that health coverage is a government responsibility
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Recently Established:
SENASA, the national health insurance authority
 SESPAS, the Ministry of Public Health and Social Assistance, is the systems
lead agency
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Source: PAHO, 2007
CURRENTLY IN DEVELOPMENT…
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Policy implementation at the ground level is encountering difficulties due to
the social and political culture of the country
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Creation of new financial steering agencies within SESPAS to process funds
from the central government (2007)
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Regional Health Services agency, whose sole mission is to provide access to
health based on geographical distribution in three levels of care
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1. primary health strategies
2. specialized care that may require hospital stays
3. regional and specialized hospitals covering delivery of more complex services
POLICY NEED IDENTIFIED
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Decentralization still needs to occur
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Increased need for transparency between agencies to identify different functions of
public health agencies (2007)
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Currently no methodologies are in place for analysis which leaves policy makers at a
standstill on best practices needed to reduce the high level of in equitability.
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Forms skewered numbers that lead many agencies to under-report their findings which
establishes ill-defined causes for public health issues
Need in human resource administration was defined as a necessity in government
strategizing
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Shortage of medical personnel, particularly
in rural areas (2007)
NEEDS CONTINUED…
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Preventive health services, a major necessity in lowering health disparities, are not
included in the basic health plan.
basic health plan administration feels that this responsibility solely relies on the state
 Population over use public hospitals, which consumes 40% of the health budget, as a
method of treating acute illnesses
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Currently, the country is in an epidemiological transition, noted decline in
infectious diseases and a noted increase in chronic non-communicable diseases
(2007).
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Preventive health models can assist in self management of illnesses and can include
populations that absorb direct services from government without contribution, such as
the disabled and elderly populations
BRA Dominicana, Monte Plata
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Humanitarian agency that coordinates local efforts to alleviate the plight of
sugarcane workers in bateyes
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Using internal resources, international grants, specialized volunteers, and
partners with other humanitarian institutions to implement projects that
provide assistance in finance management, health care/education,
agriculture and sustainability, and community development
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Current Projects:
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Unit of Integral Attention to HIV/AIDS
Prevention of Malnutrition
Medical Missions in Opthalmology
and Disaster Management
Bra Dominicana Findings
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Normative Need
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Expressed Need
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Difficulties in understanding problem, no registry of services
given, establishing which resources are available to medical
staff
More time was needed to establish concrete findings in this
area. System to track services not the culture in the country
Perceived Need
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Patient profile symptoms expressed:
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Recurrent nightmares of death, feelings of loss, emptiness,
abandonment, remembering difficulties, little motivation, low level
all daily living skills, difficulties with treatment adherence
Recommendations for Bra Dominicana
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Recommendations to incorporate Mental Health services
Identify indicators with regards to service monitoring for use in
future evaluations. This is critical to identifying any underlying
trends found in patients that might impede successful
implementation of care
 Create system of tracking services administered, especially as care
becomes highly individualized between doctor and patients
 Open dialogue within the community regarding mental health and
the types of assistance available
 Establish a mental health component to assist patients experiencing
difficulties with medication adherence due to alcohol and
substance abuse
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Educate on alcohol and substance abuse, and effects of medication,
individual counseling, family group sessions, and community open forums to
educate on the occurrences of mental illnesses
Suggestions from other Caribbean Models
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Cuban Health Model
Focuses mainly on community practice as a way to understand the
social causes of diseases
 Prioritizes at-risk individuals, as identified through neighborhood
outreach and development social welfare projects
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Chilean Health Model
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Progressive law enactments that combat severe health disparities
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Laws established had a two-fold agenda: 1. economic and policy creation and
2. reinforcement.
Laws made were with the intent to strengthen the authority of the health
ministry
Principles from other Caribbean
Health Care Models:
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Use a very practical and in depth approach, when faced with extreme
resource constrictions, of understanding inequalities as diseases that
have a cause and a cure
Develops the role of social workers as a key agent within the system.
Social workers use a multi-dimensional approach in which income is only
one factor in defining poverty
Cuba experienced an enormous diminution of infectious diseases and
sweeping improvements of socio-economic conditions (Spiegel et al,
2005)
Chilean system elevated country to second rank, contains a dual system
approach, the private and public sector
 Established integration of cash transfers with service provisions,
overseeing means of subsistence by using multiple indicators to
assess level of income and consolidation of administration
procedures (Mesa-Lago, 2008)
REFERENCES
Health
Financing and Sustainability Project. (1990). Health Services for Low-Income Families:
Extending Coverage Through Prepayment Plans in the Dominican Republic. Bethesda, MD: La Forgia,
G.M.
Jane-Llopis, E. (2004). La Eficacia de la Promocion de la Salud Mental y la Prevencion de los
trastornos mentales. Rev. Asoc. Esp. Neuropsiq., 89, 67-77.
Mesa-Lago, C. (2008). Social Protection in Chile: Reforms to Improve Equity. International Labour
Review, 147 (4), 377-402.
Pan American Health Organizatoino. Health Systems Profile: Dominican Republic 2007 [Data file].
Retrieved from
http://www.lachealthsys.org/index.php?option=com_content&task=view&id=373&Itemid=450
(accessed, 1, February, 2011).
Santana, I. & Rathe, M. (1994). Setting a New Agenda for the Dominican Republic. In Aedo, C. &
Larrannaga, O. (Eds.), Social Service Delivery Systems: An Agenda for Reform (91-126). Washington,
DC: Inter-American Development Bank.
Saracostti, M. (2003). The Chile Solidario System. The Role of Social Work. International Social Work,
51 (4), 566-572.
Saracostti, M. (2010). Constructing Chile’s Social Protection: From Early Childhood to Old Age.
International Social Work, 53 (4), 568-574.
Strug, David. (2006). Community-oriented Social Work in Cuba: Government Response to Emerging
Social Problems. Social Work Education, 25 (7), 749-762.
REFERENCES
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United Nations. Contexto General y Determinantes de la Salud [Data file]. Retrieved from
http://www.who.int/whosis/database/gis/salb_home.htm
US Agency for International Development. Dominian Republic: Country Health Statistical Report [Data file].
Retrieved from http://pdf.usaid.gov/pdf_docs/PNADO678.pdf.
US Agency for International Development. Sustained Improvement in the Health of Vulnerable Populations
in the Dominican Republic [Data file]. Retrieved from http://www.usaid.gov/dr/strategies.htm.
World Health Organization. Disease Control Priorities Related to Mental, Neurological, Developmental and
Substance Abuse Disorders [Data file]. Retrieved from
http://www.dcp2.org/file/64/WHO_DCPP%20mental%20health%20book_final.pdf.
World Health Organization & Pan American Health Organization. Dominican Republic: Health Situation
Analysis and Trends Summary [Data file]. Retrieved from http://www.paho.org/english/dd/ais/cp_214.htm
World Health Organization. Prevention of Mental Disorders Effective Interventions and Policy
Options.(2004).[Data file]. Retrieved from
http://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf .
World Health Organization and Pan American Health Organization. (2009). WHO-AIMS Report on Mental
Health Systems in Central America and Dominican Republic [Data file]. Retrieved from
http://www.who.int/mental_health/evidence/WHO-AIMS/en/.