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:
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.
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.
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.
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.
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
Human Resource Management AchievementsChallenges Creation of six (6) core Directorates: Health Services Quality Management Health Policy, and Planning Health Promotion, and Communication Finance and Projects Human Resources Information Systems Dual track employment (MOH and RHA staff) Limited capacity at RHA and MoH to undertake new roles
RHA Management Systems AchievementsChallenges Decentralised decision making Accountability Measures such as Business Plans, MoH Purchasing Intentions and Annual Services Agreements not implemented. Reductions in operation costs through bulk Purchasing
Health Services Quality Management AchievementsChallenges Report on Regulating Health care Quality finalised by Quality Management Legal expert Following key areas still absent: Risk Management Policy Framework Health Technology Assessment policy and guidelines Inventory Management and Review of Medical Record Policy and Procedures Health Services Accreditation Manual for T&T, approved and distributed to stakeholders Health Services Quality Council operational
Health Needs Assessment AchievementsChallenges Baseline Assessment (Situation Analysis) Completed First nationwide HNA not yet done
Health Information Systems AchievementChallenges Information Technology Strategic Pan including Hardware and software procurement requirements developed. IT strategic Plan revised within last 6 months Original consultancy was not of the required standard and was aborted Delays in attracting a new National IT Director The Public sectors Information backbone (platform) not yet available
Health Financing AchievementsChallenges New Technical Secretariat to spearhead alternative financing for the sector implemented within last year Numerous aborted attempts at new financing strategies have led to stakeholders scepticism
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