EXPERIENCE OF NATIONAL PROGRAMS ON COVERAGE EXTENSION IN HEALTH

Belize’s Experience

Presentation at ISSA Conference

29th May, 2006

Belize Biltmore Plaza

Ramon Figueroa, M.D, MPH

OUTLINE OF PRESENTATION Justification Social Security Changes…extension of

coverage. Pilot Project. Roll-Out. Discussion

JUSTIFICATION

Existing Gaps in Social Protection: ILO Strategies (Social Security Policy and Development Branch, Paper No.3)

Health Profile

Impact on Socio-Economic Development

ILO STRATEGIES Social Insurance, Universal benefits and

systems and social assistance programs.

Decentralized systems, micro-insurance.

Cooperative efforts between initiatives at local level (decentralized systems, social protection initiatives)

HEALTH PROFILE

Leading Causes of Mortality by Rank

Belize 2000-2004

Causes 2000 2001 2002 2003 2004

Hypertensive Diseases 2 3 1 1 1

Acute Respiratory Infections 6 5 4 2 4

Diseases of Pulmonary Circulation and Other Forms of Heart Diseases 1 2 6 3 5

HIV/AIDS 9 * 7 4 3

Transport Accidents 7 1 2 5 6

Diabetes Mellitus 5 4 5 6 2

Ischaemic Heart Diseases 4 6 3 7 7

Homicide & Injury Purposefully Inflicted on Other Persons 8 8 8 8 10

Cerebrovascular Disease 3 7 9 9 8

Other Chronic Pulmonary Disease, Diseases Due to External Agents and Residual * 9 10 10 9

Malignant Neoplasm of Digestive Organs and Peritoneum, Excluding Stomach and Colon * * * * *

Slow Foetal Growth, Foetal Malnutrition and Immaturity 10 * * * *

Accidental Drowning and Submersion * 10 * * *

Source: The Epidemiology Unit, MOH

* Means that it did not appear as one of the top ten causes for the year.

SOCIO-ECONOMIC DEVELOPMENTPercentage of the Population Living in Poverty by District

Belize 1995 and 2002

Districts

Living Standard Measurement Survey

1995 2002

Corozal 26.7 26.1

Orange Walk 24.9 34.9

Belize 24.5 24.8

Cayo 41.0 27.4

Stann Creek 26.5 34.8

Toledo 57.6 79.0

Total 33.0 33.5

Source: Central Statistical Office, Belmopan

Ratio MOH Budget as a % to GOB Budget and GDP Belize 2000-2004

8.48.68.48.69.6

2.42.52.42.4 2.5

0

2

4

6

8

10

12

2000 2001 2002 2003 2004

Per

cent

MOH/GOB% GDP%

Health Expenditure Per Capita Belize 2000-2004

142135128

125157

2937

31

3628

171171159161

185

0

20

40

60

80

100

120

140

160

180

200

2000 2001 2002 2003 2004

BZ

$

Recurrent Development Total

Literature support Negative effects of “unhealthy” population on

productivity. Decreased Income: household, contributions

to SSB, Increased Expenditure Increase in life expectancy…increased growth

in GDP!!

CHANGES IN SSBFOCUS ON HEALTH CARE………“Health is an intrinsic human right as well as a central input to poverty reduction and socioeconomic development. Cost-effective interventions for controlling major diseases exist, but a serious lack of money for health and a range of system constraints hamper global and national efforts to expand health services…”

W.H.O Publication

MODERNIZATION OF SOCIAL SECURITY.

Extension of Employment Injury Medical Care to include Private Sector.

Extension of E.I coverage to include H-W-H.

Management of National Health Insurance under umbrella of SSB.

HEALTH SECTOR REFORM AND THE NATIONAL HEALTH INSURANCE

Reform starts 1996. Financing of Health Care…National Health

Insurance. Introduction of New Paradigm in Health Care

Delivery Model. Pilot Project implemented in South Side of

Belize (pop of 36,853, poverty) Monitoring and evaluation

Separation of Function

PROVIDER

PURCHASER USER

REGULATOR

SEP

AR

AT

ION

OF

FU

NC

TIO

NS

SEP

AR

AT

ION

OF

FU

NC

TIO

NS

Health care services

Premiums/taxation/ user charges

Payments

MONITORING AND EVALUATION

PATIENT SATISFACTION SURVEYS

OVERALL PATIENT SATISFACTION BY PCP

PCP 2001 2003 2004 2005

IHC 85% 85% 91% 92%

BFLA 86% 82% 92% 90%

BMA 81% 81% 93% 95%

MR 75% 72% 89% 97%

MEDICAL RECORDS AUDIT RESULTS 2005

PCP Asthma Hypertension Diabetes Final Score

BFLA .78 .86 .89 .84

BMA .85 .84 .85 .85

IHC .55 .68 .66 .63

MR. .83 .76 .77 .79

MEDICAL RECORD AUDIT RESULTS2004 VS 2005PCP 2004 2005

BFLA .63 .84

BMA .45 .85

IHC .61 .63

MR .78 .79

PROTOCOL AUDITS, 2005BFLA BMA IHC MR AVERAGE

ASTHMA 55 86 34 65 60

DIABETES 56 62 31 60 52

HYPERTENSION 85 85 63 79 78

AVERAGE 65.3 77.7 42.7 68

FUTURE PLANS

ROLL OUT TO SOUTHERN REGION…..2006

TO NORTHERN REGION…..2007

TO WESTERN REGION…….2008

THANK YOU !

SUCCESS COMES WHEN OPPORTUNITY MEETS PREPARATION………