Health Sector Reform in Trinidad and Tobago Overview, Issues

1
Health Sector Reform in Trinidad and Tobago

• Overview, Issues Challenges.

2
Historical Review

• Julien Commission, 1957
• National Advisory council, interim Report, 1978
• Toby Commission Report, 1982

3
Health Sector Reform ProgramIADB Funded
4
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

5
Objectives

• Strengthening the policy-making, planning and
  management capacity of the health sector
• Separating the provision of services from
  financing and regulatory responsibilities
• 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
• Educing preventable morbidity and mortality
  through promoting lifestyle changes and other
  social interventions.

6
Milestones

• 1989 1992 Eight IADB missions
• 1992 Governments decision to introduce HSR
• 1993 Two teams of consultants and local
  counterparts established
• 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.

7
Features of the NHSP

• The Plans strategic intent was to guide the MoH
  in
• 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.

8
Critical Success Factor

• The strategies embodied in the NHSP reflected
  significant changes from the old order.
• 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.

9
Key Technical Requirements

• Human Resource and Change Management Strategies
  (Transition Plan)
• RHA Management Systems and Protocols
• Quality Management
• Need Assessment (National Disease Surveillance
  system)
• Health System Information Strategy
• Health Financing Strategy

10
Human Resource Management
11
RHA Management Systems
12
Health Services Quality Management
13
Health Needs Assessment
14
Health Information Systems
15
Health Financing
16
Conclusion

• HSR objectives were on target.
• HSRP design for achieving health system
  improvement was sound
• The soft components (technical know how) to
  effect the sectors full transformation lagged
  because among other things
• The general Public Sector Reform process was slow
• There was limited absorptive capacity at the MoH
  and RHAs