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Health Sector Reform

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Title: Pilot Health Authority Last modified by: Caroline Azolino Ramagem Created Date: 5/29/2006 4:51:49 AM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Health Sector Reform


1
Health Sector Reform
  • GUYANAS Experience
  • May 30th 2006
  • Dr V Mahadeo
  • CEO, BRHA

2
GUYANA
  • Located in South America with neighbours being
    Surinam, Brazil and Venezuela
  • Area of 83,000 sq miles
  • Capital - Georgetown
  • English speaking
  • Independence since 1966
  • Republic since 1970
  • Subdivided into 10 Administrative Regions

3
Health Care
  • Public and Private
  • Public Health Care is free funded by the Govt
  • All of the private hospitals are in the city
  • One medical school in Guyana (10 15 graduates
    per year)
  • Four Nursing Schools Georgetown, New Amsterdam,
    Linden and St Josephs
  • ( private)

4
  • Five levels of Health care in Guyana
  • Health Posts, Health Centres, District
    Hospital, Regional Hospital and National Referral
    Hospital.
  • The National insurance scheme runs a social
    insurance for all employed persons with mandatory
    contributions

5
A thorough study done in 1993 revealed the
following weaknesses
  • Structural weaknesses
  • Functional weaknesses
  • Cultural weaknesses

6
Structural Reasons
  • The Ministry of Health had no authority to
    implement policies or to set budgets of the
    regional administrations
  • Incomplete Regionalization
  • The population density in regions vary
  • Region 8 approx 5,737 persons while Region 4 has
    297,162 persons.

7
Functional Reasons
  • Ministry of Health and the Regional Democratic
    Councils were service providers and the
    regulatory agencies.
  • Regional Health Officers had little experience in
    planning.
  • No clear lines of authority/responsibility
    between the MoH and the RDCs, in terms of who was
    responsible for what and who reported to whom.
  • Vertical programs

8
Functional Reasons cont.
  • Duplication of functions.
  • Procurement not structured
  • Mismatch between services and health needs in the
    various regions. eg HIV
  • Most investments were at hospitals and not at
    primary levels.
  • Human resource issues

9
Cultural Reasons
  1. Decision-making was ad hoc.
  2. Attitudes to work and motivations were weak.
  3. Decision makers at various levels were not given
    autonomy and responsibility over management.
  4. Leadership deficiencies.
  5. Participation at the community level was low.

10
What has happened/is happening
  • Strengthening of health sector management.
  • Modernizing and rationalizing health services
  • Establishing workforce development and HRM
    systems
  • Implementing a national quality framework
  • Strengthening the Role of the Health Sector
    Development Unit (HSDU)
  • M E

11
Strengthening management control and capacity
  • Reorganization/Restructuring of Ministry of
    Health
  • Georgetown Hospital has become a Corporation
    (GPHC) with a board
  • Health Management Committees/Health Authorities
    -- semi- autonomous providers.
  • Performance management systems will be
    introduced.
  • Clinical targets established

12
Restructuring the Ministry of Health
  • HSDU has conducted several studies on the
    reorganization of MOH.
  • Implementation of some of recommendations have
    started, in 2003.
  • Intensification of these recommendations are
    being done ( 2004 2006).
  • Service contracts between MoH and GPHC signed.
  • MoH and RHA pilot in 2005.

13
Getting our services better managed
  • Create 4 Regional Health Authorities (RHAs)
    to cover the country
  • extensive control over resources
  • Similar to experience with GPHC
    except that the RHAs will be accountable for the
    health of their whole communities (Regions)
  • Pilot RHA has started, and would
    continue to develop.

14
Getting our services better managed
  • Phased in approach to the RHAs starting with the
    Berbice RHA and to be followed by Linden RHA
  • Allow us to learn and adjust
  • Ensure that, from the next financial year
    budgetary flows and lines of responsibility have
    been agreed between MoF, MoLG, MoH and the RDCs
  • RHAs will have boards and will receive technical
    assistance as they start up
  • Management teams will be in place.
  • Transfer of employment to the RHAs, as was done
    for GPHC (at time of corporitisation)

15
Targets for health improvement
  • Technical Programs
  • The broad priority areas are
  • Family Health
  • Non Communicable and Chronic Diseases
  • Communicable Diseases
  • HIV/AIDS/STIs
  • Oral Health
  • Environmental Health
  • Special projects

16
Modernizing and rationalizing health services
2
  • Infrastructure improvement at all levels
  • Decentralization of public health programs
  • Drug procurement and distribution systems will be
    strengthened.
  • Clinical Services improvement
  • Improved referral services

17
Infrastructure Renewal
  • GPHC phase III Construction of 460 beds in
    patient facilities
  • Hospital Prioritization and rationalization study
    completed. Based on this a capital works program
    was developed.
  • Regional Hospitals
  • - New Amsterdam completed.
  • - Linden construction of a new hospital.
    Functional plans prepared.
  • - Lethem construction of a new hospital.
  • - West Demerara capital renovations.
  • - Mabaruma hospital to be reconstructed.
  • Convert some district hospitals into polyclinics
  • Construct new health centers based on established
    criteria.
  • Health Posts construction
  • A computerized data base is being created for all
    health facilities. This would assist in timely
    maintenance of the buildings.

18
Improve procurement/distribution of Drugs
  • Pharmaceutical Study Prof. E. Seaone completed
    in 2004.
  • Materials Management Unit established.
  • Development of management team
  • Restructure the procurement system
  • Restructure the storage and distribution system.
    Additional work being done in 2005 2006. This
    includes construction of regional bonds.
  • Development of information management system.
    Additional work is being done.

19
Establishing workforce development and HRM systems
  • Workforce planning will be developed in the
    Ministry of Health.
  • Modern HRM systems is being established in
    RHA/Ministry of Health
  • Training and recruitment will be modernized for
    various categories of staff.
  • Staff appraisal systems will be streamlined in
    Health Management Committees and Ministry of
    Health.
  • System on non financial benefits introduced.
  • All these activities would be funded by the IDB
    as of 2004 2008.

20
Implementing a national quality framework
  • Standards of care is being set through
    regulation/policy.
  • New legislation to be introduced Health
    Facilities Act, Public Health Act etc.
  • Systems for clinical governance will be
    established.
  • Professional self regulation and Continuing
    Professional Development is being implemented.
    Programs to develop post graduate doctors
    training at GPHC, improvement in nurses training
    etc.
  • Capacity to monitor and evaluate is being
    developed.

21
Directing to needs improving accountability and
performance.
  • Finance will be allocated for needs and poverty.
  • Financial accountability and performance will be
    linked.
  • Capacity to work with private sector will be
    developed.
  • Regulation of private insurance to be improved.
  • Population Based Funding will be developed for
    RHAs.

22
Other NHP strategies
  • Improving financial accountability
  • Cost accounting systems the systems would move
    to assessing outputs rather than tracking line
    items inputs
  • Developing partnerships with the private sector.
    technology assessment and cost
    effective mechanism will be developed
  • Focal point to develop strategies in working with
    the private sector.
  • Development of options for regulating private
    health insurance

23
Managing the Transition
  • The Health Sector Development Unit
  • Performance Management contracts
  • Procurement of technical assistance
  • Pilot the RHA
  • Establish the HMIS
  • Strengthen Human Resource management
  • Communication
  • Capital Planning and oversee the construction of
    GPHC and Linden Hospital
  • Coordination of technical program to ensure its
    adhering to the goals of NHP
  • M and E

24
Guyana Health Sector ReformPilot RHABerbice
25
Berbice Regional Health Authority
  • From New Amsterdam to the Upper Corentyne River
    (including Orealla Siparuta)
  • Includes 1 National Hospital, 1 Regional
    Hospital, 3 District Hospitals and 26 Health
    Centres and Health Posts (1 Nursing school)
  • Caters for a population of over 120,000 persons

26
Pilot Health Authority
  • Strengths
  • Strong Support from the Minister of Health
  • Legislation passed Dec 2005 for establishment of
    Regional Health Authority in Berbice
  • Groundwork done for 2 years (2004-2005) with an
    Interim Management Committee
  • Board in Place
  • Management Team in Place (CEO 4 Directors)
  • Ongoing Training (nurses, MPTs, Doctors)

27
Minister of Health
RHA Board
CEO
Management Team
Regional Hospital
D H
HC
HC
HP
28
Getting our services better managed
  • Uncoupling of functions
  • Ministry of Health responsible for STEERING
    functions policy
  • Health Management Committee will be responsible
    for ROWING functions service delivery

Ministry of Health
RHA
RHA
RHA
RHA
29
Weaknesses
  • Regional Authorities (Regional Democratic Council
    workers) still not very supportive
  • Health budget still in the hands and under the
    control of the Regional Democratic Council
  • Some officials at the Ministry of Health still do
    not understand their role in the new system

30
Weaknesses Contd
  • Present Severe shortage of staff especially
    nurses, lab techs and junior doctors (primarily
    due to migration/active recruitment)
  • Inadequate experience of board members in
    managing of a corporate entity

31
What is being Done?
  • Regular meetings with the Regional Authorities to
    work out solutions
  • Budget for the year 2007 is being prepared and
    will be managed by the board
  • Training for Board Members
  • New nursing school and larger number of students
  • Recruitment of foreign doctors India, Cuba
    (especially specialists)

32
Contd
  • Meeting with NGOs to support the Health System
  • Community meetings started and to continue (to
    get feed back)
  • Large number of medical students presently on GoG
    scholarships to begin returning to Guyana in
    2007/2008
  • More attention being placed on Primary Health
    Care

33
  • THANK YOU !!!!
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