ministry of health, costa rica ministry of health governance of the health services of the costa...
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Ministry of Health, Costa Rica
MINISTRY OF HEALTH GOVERNANCE OF THE HEALTH SERVICES OF THE COSTA
RICAN SOCIAL SECURITY FUND
Dr. Rossana García GonzálezDirector General of Health
MINISTRY OF HEALTH OF COSTA RICA
“From treating disease to promoting health”
Ministry of Health, Costa Rica
Responsibility of the Costa Rican State
In Costa Rica the right to health is not expressed literally in the Constitution of the Republic.
The right to health can be inferred from a combination of constitutional, legal, and international regulations.
Gutiérrez, Juan José. The Right to Health in the Americas.
PAHO.1989
Garro Vargas, Fabrizio. Constitutional Framework of
the Right to Health. UCR.1994
General Health Law
Art.1 “The population’s health is a public good protected by the State.”
Ministry of Health", Costa Rica
The right to health includes
the right to access to quality health services.
Rights-based Approach Needs-based Approach Rights-based Approach
Individual is a passive recipient. Individual is an active participant.
It involves objectives, usually of partial care.
It involves the universal care imperative.
Needs may be met without guaranteeing continuity.
Needs must always be respected.
It may be organized hierarchically.
Is not organized hierarchically; all rights must be respected.
Does not involve responsibilities. Does involve responsibilities.
It is connected with a promise. It is connected with obligations.
Needs may change according to culture and circumstances.
Rights are universal.
May be met by charity. Charity is unacceptable.
Meeting needs often depends on political will.
Meeting needs is compulsory.
Ministry of Health, Costa Rica
It is a given that there are no free health services and, as a
result, there are no
beneficiaries.
The entire population has the right to health services
coverage because everyone contributes according to
his/her ability.
Conceptual and Strategic Governance Model for Social
Production of Health
Ministry of Health, Costa Rica
Equitably protect and improve the health status of the population. Equitably protect and improve the health status of the population.
Population’s Health Status
Access, quality, timeliness, continuity,
practices …
EnvironmentalSolid &Solid & liquid waste, liquid waste,
quantity & quality of water, quantity & quality of water, air & soil quality …air & soil quality …
Health Care Services for the People
GeneticGenetic factors, factors, Aging process Aging process
and other organic and other organic elements…elements…
Biological
LifestyleLifestyleIncomeIncome
Educational statusEducational statusCultural aspects …Cultural aspects …
Socioeconomic and cultural
Equitably protect and improve health status of the population.Equitably protect and improve health status of the population.
Social
Production of Health
Equitably protect and improve the health status of the population.Equitably protect and improve the health status of the population.
National Health SystemSteering
AssuranceFinancing
Health care delivery to the public and protection of the human habitat
SocialSocial
Production Production of Healthof Health
Health Sector
A series of public centralized and decentralized entities that have an explicit and legal responsibility to improve and protect the health status of the population.
Health Sector Executive Decree No. 33151-MP
• Ministry of health, regulatory authority• Costa Rican Social Security Fund (CCSS), in areas
exclusively pertaining to health• Costa Rican Institute of Water Supply and Sewerage
Systems (ICAA), in areas exclusively pertaining to health• Comprehensive Auditing of Health Services• Council on Integrated Care for Children• Council on Youth• Council on the Elderly• Institute for Drug Addiction & Alcoholism (IAFA)• Costa Rican Institute for Research and Teaching in
Nutrition and Health (INCIENSA)• Costa Rican Cancer Institute (ICCC)• Occupational Risk Section of the National Insurance
Institute• Costa Rican Institute of Sports and Recreation (ICODER)
(8 May 2006)
National System of Health Services
Consists of a series of interrelated public and private national and international entities whose basic activities include, among other things, the delivery of goods and services (final, intermediate and support), explicitly intended to protect and improve the health status of the population, regardless of whether or not they are for- or not-for profit.
National Health System (Social Production of Health)
Consists of an interrelated series of entities that have a significant impact on the socioeconomic, cultural, environmental, biological, and personal health services dimensions, as well as the determinants of human habitat protection.
Social Production of Health System
The Ministry of Health as the Steering Entity in Health
National Health System
Ministry of Health
Steering in health
Delivery of health services to the public and services for
the protection and improvement of the human
habitat
Guarantee of insurance for health services to the public
and protection and improvement of the human
habitat
Financing of health care services for the public and services for the protection
and improvement of the human habitat
Functions of the National Health System
Steering: to conduct, lead, guide, order, or exercise authority over a community, group of institutions or people.
Steering of the Health Sector: exercise of this governmental authority, management, and leadership over all sector entities (CCSS).
Steering of the National Health Services System: process whereby the regulatory authority effectively leads, promotes, and coordinates the efforts of the entities of the National Health System.
Steering of the National Health System: process whereby the regulatory authority effectively leads, promotes, and coordinates the efforts of key social actors and exercises its authority in health to protect and improve the health of the population.
Functions of the National Health System
Obligation of the National Health System to guarantee universal access to health services to the population, both for the care of individuals and for protecting and improving the human habitat, with emphasis on the vulnerable sectors of the population, especially the poorest.
Steering in health
Delivery of health services to the public and services for
the protection and improvement of the human
habitat
Guarantee of insurance for health services to the public
and protection and improvement of the human
habitat
Financing of health care services for the public and services for the protection
and improvement of the human habitat
Perspectives on Insurance
• Public perspective: The establishment, based on needs, performance, and impact criteria, of health services for individuals and services for the protection and improvement of the human habitat that cover the entire population grounded in the principles of equity and solidarity.
• Social perspective: A series of actions designed to guarantee the right of the population to receive the package of health care services and human habitat protection and improvement services established for the public.
• Financing perspective: Mechanism for protecting the people against the risk of disease and death by guaranteeing the availability of funds so that each individual has access to health services, when needed, without payment for services rendered.
Functions of the National Health System
A series of actions whereby the State, an insurance entity, or another public or private agency collects, administers, and allocates the necessary financial resources for producing or acquiring the health goods and services for the public and the human habitat protection and improvement services that should be provided to the population.
Steering in health
Delivery of health services to the public and services for
the protection and improvement of the human
habitat
Guarantee of insurance for health services to the public
and protection and improvement of the human
habitat
Financing of health care services for the public and services for the protection
and improvement of the human habitat
Functions of the National Health System
The act of providing or delivering the basic package of health services established; this includes granting individual and community health care services, in addition to services meant to protect and improve the human habitat.
Steering in health
Delivery of health services to the public and services for
the protection and improvement of the human
habitat
Guarantee of insurance for health services to the public
and protection and improvement of the human
habitat
Financing of health care services for the public and services for the protection
and improvement of the human habitat
STEERING OF THE SOCIAL PRODUCTION
OF HEALTH
Ministry of Health, Costa Rica
Substantive Steering Functions for the Social Production of Health
Social Actors Social Actors
Equitably protect and improve the health status of the population.
Public & Private Health Services
FacilitiesMinistry of Tourism
Municipalities
INS
Universities
Private commercial,,
industrial and service
establishmentsOther social
actors
NGOs (churches,
Red Cross…
ICE
Ministry of Education
ICAA Other ministries
MEIC
Ministry of Environment
& Energy
Cooperation Agencies
Ministry of Labor
Organized community
groups
Steering of Social Production of Health
Strategic Health Planning
Health Policy Orientation Health Marketing
Health Regulation
Assessment of the Impact of Actions in Health
Orientation/Modulation of Health Financing
Harmonization of Health Service Delivery
Health Surveillance
International Organizations
Ministry of Health, Costa Rica
Ministry of Health Steering of the Health Services of the Costa Rican Social Security Fund
Health Policy Orientation
Setting priorities and establishing political guidelines, assisting with the implementation of strategic actions and advocacy for securing resources.
Marketing ofHealth
Positioning the health promotion strategy in the CCSS health services and the culture of non- exclusion among the institution’s staff.
Health SurveillanceMonitoring the coverage and quality of CCSS health services and their determinants.
Strategic Health Planning
Setting priority goals and objectives for implementation of the national health services policy and developing plans, programs, and projects for attaining these goals and objectives.
Regulating HealthDefining and controlling the health services regulatory framework.
Regulating the Health Services of the Costa Rican Social Security Fund
• Operating license (authorization): compulsory, emphasis on structural indicators.
• Accreditation: voluntary, includes process indicators.
• Quality assessment: - Assessment of first-level care health services
(structure-process-outcome). - Analysis of deaths in children. - Analysis of maternal deaths. - Tracer evaluation. - Addressing complaints.
Ministry of Health, Costa Rica
Ministry of Health, Costa Rica
Ministry of Health Steering of the Health Services of the Costa Rican Social Security Fund
Orientation/Modulation of Health
Financing
Approval and monitoring of the funding allocated in the CCSS for addressing the priorities set in the National Health Policy and determining corrective measures when deviations are found.
Harmonization of Health Services
Harmonization of CCSS health services with other the services of other providers.
Impact Assessment of Health Actions
Assessment of the impact of the priority plans, programs, and projects of the CCSS related to national health policy.
Strategies for Operationalizing Steering in Health
Health sector reform: Separating the steering and health service delivery functions.
Identifying the roles of National Health System institutions in terms of the steering, insurance, financing, and service delivery functions.
Intensifying the decentralization of the Ministry of Health.
Separation and complementation of central, regional, and local functions.
Strategies for Operationalizing Steering in Health
Design and dissemination of the Conceptual and Strategic Model for Steering of the Social Production of Health.
Steering based more on leadership than on “legal authority.”
Adjustment of the Ministry of Health’s Strategic Framework.
Implementation of organizational development: functions – products - processes – procedures - structural adjustment - human resource profiles.
The greater danger for most of us lies not in setting our aim too high and falling short;
but in setting our aim too low, and achieving our mark.
Miguel Angel(Paraphrased from: daily inspiration from The Monk
who Sold his Ferrari: A spiritual fable… By: Robin S. Sharma)
Ministry of Health, Costa Rica
Thank YouThank You!!