anguilla monitoring health systems change/health reform presented by dr. bonnie richardson-lake
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AnguillaAnguilla
Monitoring Health Systems Change/Health Reform
Presented by Dr. Bonnie Richardson-Lake
Background
• Most Northerly of the Leeward Islands
•United Kingdom Overseas Territory
•A Governor appointed by the Queen presides over an Executive Council made up of 4 Local Government Ministers, the Deputy Governor and the Attorney General
•35 Square miles
•2001 Census--11,561
•2003 Population Estimate--12,200
Economic Activity
•GDP per capita-- EC$20,733 or US$7,736 in 2003
•Tourism sector makes the largest contribution to GDP—28%
•Government Sector--18.7%
•Finance Sector--14.4%
•According to the 2001 census 75% of those 15 and older were a part of the workforce.
Health Indicators 2005
•Infant mortality rate 18.0
•No maternal deaths 2001-2005
•Birth Rate 11.4 per 1,000 (2003)
•Male life expectancy--76.52
•Female life expectancy--81.1
Top Causes of Death (2004)
•Cancer
•Diabetes
•Heart Disease
•Stroke
Health Care System
•Health care system is comprised of both private and public sector
•Public sector health care is delivered by the Health Authority of Anguilla
•Primary Health Care is provided in five health centres throughout the three health districts
Primary Health Care
Health Centres are staffed by: •Physicians•Pharmacist•Dentist•Public Health nurses•Nurse midwives•Physiotherapist•Community health aides•Clinic aides
Primary Health CareServices provided:
•Maternal and Child health•Family Planning•Immunization, •Nutrition advice•Care of the elderly•Management of chronic diseases•Health education. •Pharmacy Services•Physiotherapy•Home Visiting•General Medical Care•Community Mental Health
Secondary Care
Princess Alexandra Hospital is a 36-bed facility which provides:•Emergency treatment •Surgical Care•General medical•Pediatric•Gynecological and obstetric care •Laboratory services•Radiological and Diagnostic services•Pharmacy services•Physiotherapy
Secondary Care
•Long-term Care—16 bed senior citizen’s home
•A 12 bed in-patient psychiatric wing is currently under construction and should be commissioned by the end of this year
•The unit will provide services to those with acute psychiatric illness
Anguilla’s Health Care Reform
In 2000 the Government of Anguilla (GoA) took the decision to place the delivery of health care services under a semi-autonomous statutory body—The Health Authority of Anguilla (HAA)
Anguilla’s Health Reform•GoA was committed to attaining the most productive use of resources and a more timely response to the overall requirements of the health service.
•One of the main objectives of the reform was to attain a greater degree of efficiency in health services and an improvement in the delivery of quality health care
•Having HAA separate from the Ministry of Health (MoH) removed much of the bureaucracy typically associated with the general Public Service
Anguilla’s Health Reform
Management responsibilities delegated to the HAA included:
•Financial
•Human Resource
•Operational Delivery of Health Care Services
Advantages of a Decentralized Model
The devolution of the health services has several advantages:
•Increased speed and clarity in decision-making and implementation
•Health care can best be administered within the framework that allows institutions to manage their resources (both financial and human) directly
•More empowered health officials with greater responsibility for the outcome of decisions
Advantages of a Decentralized Model
•Increased Sustainability
•Improved Equity
•Increased Quality
Role of the MoH
•After the devolution of the health services to the HAA, MoH maintained the following functions:
•Policy direction
•Strategic Planning for Health
•Regulatory/licensing functions
•Monitoring & Evaluation
Preparatory Work
Before the HAA could be commissioned several critical activities had to be undertaken. These include:
•Establishment of a Health Authority Project Board to recommend an implementation strategy and later the establishment of a Shadow Board
•Governance Structure of the HAA
•Legislative Framework—a bill for the establishment of HAA was developed with the assistance of an international legal experts
Preparatory Work•Development of personnel policies and transition arrangements
•Development of financial management systems
•Communication Plan for staff and public
•Development of a National Strategic Plan for Health and subsequent service plans
•Development of service agreements and new performance measurement systems
•Selecting and training of key managers and Board Members
Preparatory Work
All of the activities were coordinated by regional consultant funded by DFID
HAA
The HAA was commissioned in December 2003 and became operational in January 2004 under the Health Authority of Anguilla Act
Structure of HAA
Minister ofHealth
HAA Board
Chief Executive
Officer
Director of Nursing Services
Human Resource Manager
Finance Manager
Facilities Manager
Director of Medical Services
Coordinatorof HealthPromotion
MoHMinister of Health
PS Health
Health PlannerDirector of Quality Management/CNO
Quality Management Officer
National AIDS Programme Coordinator
Strengthening Health Systems
National Health Fund:
It is proposed that a National Health Fund (NHF) is created to purchase health care for the whole population of Anguilla as clinically needed and in an equitable manner.
National Health Fund
The NHF has been based on the guiding principles of social health insurance which include:
solidarity - pooling the financial risk for the whole populationsustainability - creating an independent funding mechanism able to match revenue to needs
NHF
equity - introducing a prospective payment system removing financial barriers to access efficiency - avoiding the fragmentation and high overheads of multiple funding sourceseffectiveness - developing technical purchasing capacity in the NHF accountability - including mechanisms transparency and consumer involvement.
NHF
The Fund will be managed to ensure that money is spent on high-quality, value-for-money services, and not wasted on unnecessary treatment. Individuals will contribute to the Fund when they are economically active, but the Fund will pay for care for everyone as it is needed, including children and the retired
NHFIt will be financed by a combination of:
•Contributions from employers and employees based on income•An annual GoA contribution from the Consolidated Fund (which may result in a new levy or levies on the consumption of selected items)•Any other sources as may be decided by ExCo from time to time.
HEALTH AUTHORITY OF ANGUILLA
HEALTH SYSTEM ACCREDITATION
ACHIEVING IMPROVED MEASUREMENT (A.I.M.)
WITH
CANADIAN COUNCIL ON HEALTH SERVICES ACCREDITATION
OBJECTIVES OF ACCREDITATION
• PROVIDES A BASIS FOR ENSURING MINIMUM
STANDARD OF CARE BENCHMARKED AGAINST
INTERNATIONAL STANDARDS
• SERVES AS VECHILE FOR DRIVING CONTINUOUS
QUALITY IMPROVEMENTS
• SERVES AS A BASIS FOR PROMOTING
ORGNAIZATIONAL TRANSFORMATION AND CHANGE
• ESTBALISHES A BASIS FOR SUSTAINED SYSTEMS
DEVELOPMENT
OBJECTIVES OF ACCREDITATION (CON’T)
• TOOL FOR ESTABLISHMENT OF GOOD
QUALITY AND INCREASED PUBLIC
CONFIDENCE IN PUBLIC HEALTH
SERVICES
• INCREASED ORGANIZATIONAL
CREDIBILITY AND ACCOUNTABILITY
Strengthening the capacity of MoH
The MoH has sourced a consultant to assist with the following objectives:
• Development of a performance measurement framework
• Examination and assistance in improving the Anguilla MoH Quality Management program including staff training.
Strengthening the capacity of MoH
•Integrate epidemiology to enhance the use of information and the effectiveness of policy making, program development, and assessment related to population health.
•Evaluate and help improve the Ministry’s Health Planning functions.
Other Interventions to Strengthen Health Systems
•Establishment of a Department of Health Protection including the appointment of a Chief Medical Officer, Surveillance Officer, and Epidemiologist
•Updating of Environmental Health Legislation
Other Interventions to Strengthen Health Systems
•Development of legislation to regulate health professionals
•HAA surveillance officer identified and dedicated specifically to surveillance activities
•Establishment of Quality Management Unit
New Approaches to Health Systems Management
•Annual Services Agreement in effect
•Performance Appraisal Process implemented
•Recognition and Reward programme established
•Quarterly reviews in effect
•Operational planning framework implemented
•Full delegation of budget to managers
New Approaches to Health Systems Management
•Board Committees established – Patient care, Nursing, Human Resources and Finance
•Management Committees established – Quality and Audit, Health and Safety, Disaster Management and Information Management being implemented
•Instrument of Communication (MoH/HAA) being implemented
Framework of Objectives to evaluate Health Sector Reform
•Access
•Equity
•Quality
•Effectiveness
•Efficiency
•Sustainability
Access
2003 2004 2005
Facilities with a doctor (PHC)
0 2 2
Pharmacy 1 3 3
Immunization Coverage
100% 100% 100%
Equity
2003 2004 2005
Spending on PHC
3,145,000 2,960,000 3,445,000
Spending on secondary
7,200,000 6,050,000 6.820,000
Capital Investment
395,000 375,000 700,000
EFFECTIVENESS
2003 2004 2005
Crude Birth Rate
14.1 14.5 14.3
Crude Death Rate
5.6 5.5 5.4
In-patient deaths
32 23 23
Efficiency2003 2004 2005
Bed Occupancy
41% 31% 21%
Average length of stay (days)
5 4 3
% of expenditure on personnel
61% 79% 69%
Sustainability
2003 2004 2005
% of spending from Government
100% 77% 79%
Current Ratio
NA 1.6:1 1.7:1
Working
Capital
NA 582,000 817,000
Health spending to GDP
5.4% 5.3% 5.4%
Client Satisfaction
•80% of patients view doctors as professional and caring
•78% of patients described the food as very good / good on taste, appearance and choice
•94% of patients viewed the physical environment as very good / good compared to 64% in 2004
•95% of dental patients felt their needs were met
•85% of dental patients viewed staff as prompt and helpful in 2005 compared to 73% in 2004
Source: Health Information Department
“There is a need for change to ensure quality, efficiency, equity, cost containment, financial sustainability, and inter-sectoral collaboration. The outcome of this new dispensation of change seeks to give the people of Anguilla greater access to health services and empower individuals and communities to assume responsibility for their health.”
---Source: Anguilla’s National Strategic Plan for Health
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