Presentation on theme: "Anguilla’s Health Reform:"— Presentation transcript:
1 Anguilla’s Health Reform: Towards Strengthening Health Systems and Improving Health Care ProvisionPresented by Dr. Bonnie Richardson-LakePermanent Secretary Health & Social Development
2 OutlineBackgroundEstablishment of the Health Authority of Anguilla (HAA)New Role for the Ministry of HealthThe National Health FundOther Initiatives
3 Background United Kingdom Overseas Territory Most Northerly of the Leeward IslandsUnited Kingdom Overseas TerritoryA Governor appointed by the Queen presides over an Executive Council made up of 4 Local Government Ministers, the Deputy Governor and the Attorney General35 Square miles2001 Census--11,5612006 Population Estimate—14,000
4 Economic Activity GDP per capita-US$ 6,718 in 2005 5% of GDP was spent on health care in 2005(approx 15% of total govt budget)Tourism sector makes the largest contribution to GDP—28%Government Sector--18.7%Finance Sector--14.4%Less than 1% unemployment
5 Health Indicators 2005 Infant mortality rate 18.0 No maternal deathsBirth Rate 11.4 per 1,000 (2003)Male life expectancyFemale life expectancy--81.1You can see from these indicators that overall health is relatively good. However Anguilla like most countries in the region continue to struggle with the control of Chronic non-communicable disease like diabetes, hypertension and cancers
6 Top Causes of Death (2004)CancerDiabetesHeart DiseaseStroke
7 Health Care SystemHealth care system is comprised of both private and public sectorPublic sector health care is delivered by the Health Authority of AnguillaPrimary Health Care is provided in five health centres throughout the three health districts
8 Primary Health Care Health Centres are staffed by: Physicians PharmacistDentistPublic Health nursesNurse midwivesPhysiotherapistCommunity health aidesClinic aides
9 Primary Health Care Services provided: Maternal and Child health Family PlanningImmunization,Nutrition adviceCare of the elderlyManagement of chronic diseasesHealth education.Pharmacy ServicesPhysiotherapyHome VisitingGeneral Medical CareCommunity Mental Health
10 Secondary CarePrincess Alexandra Hospital is a 36-bed facility which provides:Emergency treatmentSurgical CareGeneral medicalPediatricGynecological and obstetric careLaboratory servicesRadiological and Diagnostic servicesPharmacy servicesPhysiotherapy
11 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 yearThe unit will provide services to those with acute psychiatric illness
12 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)
13 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 careHaving HAA separate from the Ministry of Health (MoH) removed much of the bureaucracy typically associated with the general Public Service
14 Anguilla’s Health Reform Management responsibilities delegated to the HAA included:FinancialHuman ResourceOperational Delivery of Health Care Services
15 Advantages of a Decentralized Model The devolution of the health services has several advantages:Increased speed and clarity in decision-making and implementationHealth care can best be administered within the framework that allows institutions to manage their resources (both financial and human) directlyMore empowered health officials with greater responsibility for the outcome of decisionsDecisions are made at the service delivery or board levelDept heads control their own budgets—programme budgeting
16 Advantages of a Decentralized Model Increased SustainabilityImproved EquityIncreased Quality
17 Preparatory WorkBefore 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 BoardGovernance Structure of the HAALegislative Framework—a bill for the establishment of HAA was developed with the assistance of an international legal experts
18 Preparatory WorkDevelopment of personnel policies and transition arrangementsDevelopment of financial management systemsCommunication Plan for staff and publicDevelopment of a National Strategic Plan for Health and subsequent service plansDevelopment of service agreements and new performance measurement systemsSelecting and training of key managers and Board MembersOfficers were not given a choice in transfer, but were moved up a step in the pay scale. Legislation is written so that public officers who moved to HAA are not worse off than before the transfer.Strat plan provided direction for the development of the operational plans of each of the departments under the HAA
19 Preparatory WorkAll of the activities were coordinated by regional consultant funded by DFID
20 HAAThe HAA was commissioned in December 2003 and became operational in January 2004 under the Health Authority of Anguilla Act
22 MoHThis represents just the health portion of the Ministry of Social Development.
23 Role of the MoHAfter the devolution of the health services to the HAA, MoH maintained the following functions:Policy directionStrategic Planning for HealthRegulatory/licensing functionsMonitoring & Evaluation
24 Strengthening the capacity of MoH The MoH has sourced a consultant to assist with the following objectives:Development of a performance measurement frameworkExamination and assistance in improving the Anguilla MoH Quality Management program including staff training.
25 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.
26 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.The NHF is based on a primary health care model
27 Pre-requisites for the Establishment of the NHF The provision of the Health Services be removed from political interferenceEstablishment of the HAAQuality of health services improvedAccreditation of the HAA by the Canadian Council on Health Services AccreditationNHF management must be free from political interferenceEstablishment of the NHF Board and the recruitment of the NHF Director
28 National Health FundThe 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
29 NHFequity - introducing a prospective payment system removing financial barriers to accessefficiency - avoiding the fragmentation and high overheads of multiple funding sourceseffectiveness - developing technical purchasing capacity in the NHFaccountability - including mechanisms transparency and consumer involvement.
30 NHFThe 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
31 NHF It will be financed by a combination of: Contributions from employers and employees based on incomeAn 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.
32 Financing OptionsContributions of 5% of monthly income; 2.5% from employers and 2.5% from employeesan annual GoA contribution from the Consolidated Fund which will includeMonies used to pay for health coverage for Civil ServantsMonies allocated to medical treatment overseasMonies currently paid to the Health Authority of AnguillaAny other sources as may be decided by GoA Executive Council from time to time
33 Anguilla NHF Operations The Fund will buy health care services from providers offering services to a standard acceptable to the FundIt will be managed by a technical capacity able to negotiate quality and prices with providers.
34 Anguilla NHF Operations Providers will include the HAA and approved private practitioners.Selected overseas hospitals will provide specialist tertiary care that cannot be provided adequately on-island
35 Payment for Procedures Primary care will be purchased by the Fund for consumersProviders will be contracted (through an annual service agreement) based on the number of consumers registered with them, and not on a fee-per-item-of-service reimbursement basis.
36 Anguilla NHF Operations Access to hospital and specialist care paid for by the Fund will be through referral by approved primary care providers only.Access to sub-specialist care overseas paid for by the Fund will be only through referral by approved secondary care providers – in practice, the HAA.
37 Anguilla NHF Operations Overseas specialist care will be purchased on a fee-for-service basis but under pre-agreed unit rates. Charges, utilisation rates and the validity of treatment will be monitored by the Fund to maintain quality and value-for-money, and to stay within budget.
38 Patient RegistrationProviders will be accredited to provide services under the NHF subject to the satisfaction of the Director of the NHF that services provided are of a sufficiently high standard
39 Patient RegistrationConsumers will be required to register at one primary care provider within 3 months of registering with the NHFThey may do this at the start of the Fund’s operations or when they visit a provider for the first time.
40 Patient RegistrationAll dependents and family members will register with the same provider and providers will be limited by a maximum list size in order to ensure quality of careThe maximum list size will be decided by the Fund but is likely not to exceed 2,000 persons to include NHF-funded and non-NHF patients.
41 Patient RegistrationProviders are prohibited from excluding patients wishing to register with them until the maximum list size of patients has been reached.
42 Patient RegistrationPatients may register with another provider under the following conditions:the receiving provider has space on his/her register for the entire familyat least 30 days noticechanges cannot exceed more than 3 in a calendar year
43 Other Interventions to Strengthen Health Systems Establishment of a Department of Health Protection including the appointment of a Chief Medical Officer, Surveillance Officer, and EpidemiologistUpdating of Environmental Health Legislation
44 Other Interventions to Strengthen Health Systems Development of legislation to regulate health professionalsHAA surveillance officer identified and dedicated specifically to surveillance activitiesEstablishment of Directorate of Health Services Quality Management
45 Expansion of MoH Human Resources Approval of post for Surveillance Officer for the MinistryEstablishment of a Health Planner post separate from planning in other social sectorsExpansion of the Directorate of Health Services Quality ManagementExpansion of the National AIDS Programme
46 New Approaches to Health Systems Management Annual Services Agreement in effectPerformance Appraisal Process implementedRecognition and Reward programme establishedQuarterly reviews in effectOperational planning framework implementedFull delegation of budget to managers
47 New Approaches to Health Systems Management Board Committees established – Patient care, Nursing, Human Resources and FinanceManagement Committees established – Quality and Audit, Health and Safety, Disaster Management and Information Management being implementedInstrument of Communication (MoH/HAA)
48 Framework of Objectives to evaluate Health Sector Reform AccessEquityQualityEffectivenessEfficiencySustainability
49 Access200320042007Facilities with a doctor (PHC)23Pharmacy1Immunization Coverage100%
50 AccessThe reorganization and expansion of primary health care, more patients have access to core basic package of primary medical careThe establishment of health districts and the availability of a health team comprised of family physicians and professional nursing staff, these centres now provide a more sustained and reliable package of services from 8.00 a.m. to 4.00 p.m.The result has been a decrease in the number of non-emergency cases in the A&E
51 Equity200320042005Spending on PHC3,145,0002,960,0003,445,000Spending on secondary7,200,0006,050,0006.820,000Capital Investment395,000375,000700,000
53 Efficiency 2003 2004 2005 Bed Occupancy 41% 31% 21% Average length of stay (days)543% of expenditure on personnel61%79%69%
54 Sustainability 2003 2004 2005 100% 77% 79% Current Ratio NA 1.6:1 % of spending from Government100%77%79%Current RatioNA1.6:11.7:1WorkingCapital582,000817,000Health spending to GDP5.4%5.3%
55 Client Satisfaction80% of patients view doctors as professional and caring78% of patients described the food as very good / good on taste, appearance and choice94% of patients viewed the physical environment as very good / good compared to 64% in 200495% of dental patients felt their needs were met85% of dental patients viewed staff as prompt and helpful in 2005 compared to 73% in 2004Source: Health Information Department
56 “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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