1. BARBADOS Trends in Health System Change and Health Sector Reform

2. Social and Political Context estimated mid- year population of 273,018 in 2005 sustained GDP growth averaging 3% p.a. fiscal deficit of 2.5% of GDP Per capita GDP of US $7,950 ( 2002)

3. Social and Political Context contd Tourism remains one of the main foreign exchange earners and employers of labour International and Financial Business Services sector is a growing source of foreign exchange Construction is buoyant with increasing output Agriculture contribution to GDP is declining although non-sugar agriculture and fishing increased during the period.

4. Social and Political Context Contd Unemployment rate fell to single digits from 2001. Female participation rate in the labour force has been increasing Adult literacy rate of 99% in 2004. Approx. 66.7% of persons enrolled in tertiary institutions are females Infant mortality declined from 13.3 per thousand births in 2002 to 10.1 in 2004, rose to 12.3 in 2005 Maternal Mortality ratio – one and two maternal deaths in 2002 and 2003 respectively. Nil in 2004 and 2005.

5. Social and Political Context Contd Perinatal mortality is a challenge – fluctuating between 18.6 in 2003 to 15.8 per thousand births in 2005. Life expectancy at birth – 72.6 years for men and 78.3 years for women 1997 Poverty Study found 15% of the population lived below the poverty line of BDS $5,503 p.a.

6. Leading Causes of Death Disease of pulmonary circulation and other forms of heart disease Cerebrovascular diseases Diabetes mellitus Ischaemic Heart Disease Malignant neoplasms of digestive organs except stomach HIV/AIDS

7. Leading Causes of Death Pneumonia Hypertension Malignant neoplasm of prostate Septicaemia Acute respiratory infection Malignant neoplasm of the female breast

8. Priorities for Change Management systems – linking planning and budgeting cycles; - policy formulation process that is responsive to globalization Financing Systems - provider – payment mechanisms; cost and management accounting systems in institutions Improving healthcare quality and efficiency Improving equity of access

9. Priorities for Change Contd Health Promotion policy Human resource management Management information systems

10. Public Sector Reforms That Impact on Health Sector Reform Multi-year budget cycle (three years) Accrual accounting to replace cash accounting Information systems policy Human resources - performance management system

11. Barbados Strategic Plan for Health 2002-2012 Provides the Health Reform Agenda for the country Identifies the Priorities for Action – these are in keeping with the Caribbean Cooperation in Health initiative Has become the blueprint in negotiations and collaboration with donors and other stakeholders

12. Health System Changes Already Being Implemented Contractual arrangements with non-state providers with respect to the following services: 1.Care of the elderly 2.Provision of treatment for drug abuse Autonomy of the Management of the Queen Elizabeth Hospital

13. Health System Changes Being Implemented Mental Health Reform – the policy approved by the Cabinet of Barbados places emphasis on prevention and community- based treatment.

14. Health System Change Through Technical Cooperation PAHO - BPB EU – Sector budget support along with technical assistance

15. Technical Assistance to the MOH includes: Reorganising and strengthening the steering role of the MOH Strengthening family health services, specifically initiating interventions in home and community- based care for the elderly and the disabled Reorganising and strengthening health promotion – policy; management framework which includes health promotion support unit and implementation plan.

16. Technical Assistance to the MOH includes Contd : Development of information systems to provide relevant and timely information at all levels for decision making - HIS in all institutions - A central Health Information Unit - Updated surveillance system Development of cost accounting systems

17. Technical Assistance to the MOH includes Contd: Development of modern cross-cutting approaches to the management of CNCDs, starting with cardio vascular disease. Formulation of policies to strengthen human resource management:- recruitment and retention; training; job satisfaction; appraisal.

18. The End Prepared by Samuel Deane Planning and Research Unit Ministry of Health Barbados