Eastern Caribbean CountriesHealth Systems and Private Sector Assessments

2011

Lisa TarantinoAntigua and Barbuda Assessment Team

Abt Associates, Inc.April 24, 2012

7 Countries Assessed

1. Antigua and Barbuda2. Barbados3. Dominica 4. Grenada5. St. Kitts and Nevis6. St. Lucia7. St. Vincent and the

Grenadines

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Objectives

Improve sustainability of systems and HIV/AIDS programming in view of diminishing donor funding (PEPFAR funded)

An overview of the entire health sector organized around the six HSS building blocks

A description of pressing health issues and priority system challenges

A summary of private sector contributions to health Actionable recommendations to strengthen health system and

leverage private health sector Develop action plans for addressing priority recommendations

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Guiding Principles

Holistic view of the health system – comprised of public, private (for-profit) and NGO/FBO elements

Collaborative, high level of engagement with partners and stakeholders: MOHs, private sector, USAID, PAHO, NGOs, etc.

Given declining vertical funding for HIV/AIDS, need for integration into existing health systems and services

Recommendation criteria: Contributes to the sustainability of the health system System focused and addresses key performance criteria

Equity, Access, Quality, Efficiency, Sustainability Feasible in short term, essential in long term

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KEY FINDINGS: ANTIGUA AND BARBUDA

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Governance and Leadership

Strengths and Opportunities PHC level is well managedMOH works with professional councils, which are activeMedia has a public information service and a watchdog functionNeighboring country laws and regulations can be easily adaptedInternational guidelines used for environmental health & sanitationPublic sector reform may impact health sector positively

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Weaknesses and Threats Government budget constraintsInadequate reporting impacts accountability (CBH, MSJMC, MOH)

MOH needs human resources for planning and developing regulations

Inadequate strategic planning

Significant gaps in legislation and regulation of the health sector

Some infrastructure investment needed (MOH)

Human Resources for Health

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Weaknesses and ThreatsLack of a comprehensive HRH policy Absence planning mechanism in MOHAd-hoc transfers of personnel results in loss of capacity, mismatch of personnel and needs of institutions, demotivation Established/Non-Established disparities impacting moraleLimited personnel and services in dental psychiatric/mental health, rehabilitationPharmacy school viabilityLimited supervisory and appraisal capacity in primary health care

Strengths and OpportunitiesHigh levels of competence and dedication exist Adequate number of health workers across most cadres & specializationsScholarships to support trainingHealth training services exist, eg nursing school, relevant faculties of UWI to support pre and in-service training (MSJMC internship program)Public Sector Modernization presents opportunity to address anomalies in staff designations & conditions of employment

Service Delivery

Strengths and Opportunities

Strong primary care, particularly for infectious diseases, maternal and child health

Adequate number of facilities, distributed evenly across the country (both public and private), new hospital

Most specialized tertiary care available in-country

Infrastructure and education/literacy of the population

Weaknesses and ThreatsNo system for quality assurance of health servicesEfficiency of service delivery not optimal

Over reliance on MSJMC for minor health issues

Centralized HIV/AIDS treatment Gaps in patient referral process

Insufficient health promotion and education

Health Information Systems

Strengths and Opportunities

Adequate physical resources for HIS in the public sector

Established routine data collection and reporting process at primary health care facilities

Established surveillance system

Weaknesses and Threats

Fragmentation of the HIS: Routine data from MSJMC is

not collected by MOH (except for surveillance)

Private facilities not part of the system

Separate data collection and processing systems for different types of HIV/AIDS data

Efficiency of data management at central levelInadequate use of data for planning

Pharmaceuticals & Medical Products

Strengths and Opportunities

Sufficient pharmaceutical human resources, facilities Good access to quality pharmaceuticalsCollaborative relationship with PPS in procuring and monitoring pharmaceuticalsExistence of national and regional training programs Adequate financial resources for procurement

Weaknesses and Threats

Weak regulatory frameworkInsufficient monitoring/regulation of facilities and pharmaceuticals, especially in the private sectorInadequate Pharmaceutical MIS/data for decision making Inadequate pharmaceutical management coordinationAbsence of Standard Operating Procedures Lack of standard treatment protocolsInconsistent pharmacovigilence practices

Health Financing

Strengths and Opportunities

7% payroll tax (with no ceiling salary) committed to health care

Public services available without significant financial barriers

15-20% of population has private insurance (about 15,000 people)

Not a huge need for major capital investment (MSJMC)

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Weaknesses and Threats

Lack of available data on what existing service commitments really cost or projections on funding growth in future. Fragmented financing: No good data on total public health expenditure. Growing burden of chronic disease, where primary health system is weakest. There is a danger that tertiary care commitments will erode the primary care system.

KEY RECOMMENDATIONS

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St. Lucia, Antigua and Barbuda, Dominica

1. Prepare population and leadership for the fact that system is not currently sustainable, and build political will for change (Antigua and Barbuda)

2. Invest in financial analysis (costing, NHA) and strategic planning

3. Prioritize updates and passage of key legislation and gazette regulations to enforce enacted laws

4. Improve efficiency and quality at all levels of care (strengthen referral system, collect and use data from hospital, private sector)

5. Pursue opportunities to engage the private sector as a partner13

Next steps – Action!

1. Dissemination and validation workshops resulted in: Prioritization of recommendations by public and private sector

stakeholders

Action steps discussed, negotiated and agreed

2. Commitments by development partners to consider prioritized recommendations and plans

3. Technical support sought and accessed from USAID (and others)

4. Technical support initiated in areas of health financing strengthening (costing) and private sector mapping

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Thank you!

Lisa TarantinoAntigua and Barbuda Assessment Team

Abt Associates, Inc.April 24, 2012