4 Goal of HSRPTo 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:
5 ObjectivesStrengthening 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.
6 Milestones 1989 – 1992: Eight IADB missions 1992: Government’s decision to introduce HSR1993: Two teams of consultants and local counterparts established1994: 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.
7 Features of the NHSPThe Plan’s 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; andEffectively work with provider agencies.
8 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.
9 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 StrategyHealth Financing Strategy
10 Human Resource Management AchievementsChallengesCreation of six (6) core Directorates:• Health Services Quality Management• Health Policy, and Planning•Health Promotion, and Communication• Finance and Projects•Human Resources• Information SystemsDual track employment (MOH and RHA staff)Limited capacity at RHA and MoH to undertake new roles
11 RHA Management Systems AchievementsChallengesDecentralised decision makingAccountability Measures such as Business Plans, MoH Purchasing Intentions and Annual Services Agreements not implemented.Reductions in operation costs through bulk Purchasing
12 Health Services Quality Management AchievementsChallengesReport on Regulating Health care Quality finalised by Quality Management Legal expertFollowing key areas still absent:• Risk Management Policy Framework• Health Technology Assessment policy and guidelines• Inventory Management and• Review of Medical Record Policy and ProceduresHealth Services Accreditation Manual for T&T, approved and distributed to stakeholdersHealth Services Quality Council operational
13 Health Needs Assessment AchievementsChallengesBaseline Assessment (Situation Analysis) CompletedFirst nationwide HNA not yet done
14 Health Information Systems AchievementChallengesInformation Technology Strategic Pan including Hardware and software procurement requirements developed. IT strategic Plan revised within last 6 monthsOriginal consultancy was not of the required standard and was abortedDelays in attracting a new National IT DirectorThe Public sector’s Information backbone (platform) not yet available
15 Health Financing Achievements Challenges New Technical Secretariat to spearhead alternative financing for the sector implemented within last yearNumerous aborted attempts at new financing strategies have led to stakeholders’ scepticism
16 Conclusion HSR objectives were on target. HSRP design for achieving health system improvement was soundThe soft components (technical know how) to effect the sector’s full transformation lagged because among other things:The general Public Sector Reform process was slowThere was limited absorptive capacity at the MoH and RHAs