The Government of Saint Lucias vision for the continued development of the Health Sector is best articulated in its "Contract of Faith" with the people of Saint Lucia. The Deputy Prime Minister, Honourable Mario Michel, brought these sentiments to the fore at the two-day Preparatory Meeting on Health Sector Reform. This meeting was held on July 31st and August 1st 1998 under the theme Guaranteeing Quality Health Service.
While the government has initiated the process of Health Sector Reform, the involvement, contributions and consensus to the process must be representative of the thinking of the wider population (inclusion of private and non government sector). There needs to be a systematic approach to the Reform process encompassing structural and organizational changes that must require a firm commitment by stakeholders.
The Health Minister, in pursuing the vision for Health Sector Reform established a mechanism for change starting with the formation of a Health Sector Reform Committee. The work of this committee lead to the establishment of a Health Sector Reform Secretariat. In keeping with the direction set by the Health Sector Reform Committee, the Secretariat proceeded to execute a major step of the reform process by hosting a two-day Preparatory Meeting, thus embarking on the consultative approach.
This document highlights the outcome of the Preparatory Meeting the First Consultation. At this meeting, key persons within the Health Sector, and other stakeholders were, invited to participate. Also specially invited by the Ministry were PAHO consultants Dr. Kenwyn Nicholls who has a wealth of experience in Health Sector Reforms issues, and Dr. Anton Cumberbatch, Health Care Financing expert. This initiative was testimony to the need for broad-based consultation.
The objectives of the meeting were to sensitize the various stakeholders on the importance of Health Sector Reform, to harness feedback on key policy issues and to help develop strategies for the growth and development of the Reform Process. During the meeting, participants discussed and made presentations on Health Sector issues under the following board areas:
The main theme of the discussion presented by the working group on District Health Teams and Community Based Care was that of self-determination and empowerment of community members. Group members were convinced that improved community care depended upon community members playing a greater role in the management of community services. Some of these functions included planning, coordinating and reporting on programs. Members identified the need for quality assessments, expansion of health advisory services and institutional strengthening within the community. The work of the District Health Teams were seen as critical to the development of community based care. Their collective skills were seen and understood as being essential to the direct delivery of services to targeted groups in the community.
The group on Health Sector Financing comprised persons who represented areas of finance, insurance and administration in both the public and private sector. They concluded that it was necessary to review the cost of health care services, assess to what extent they are under-financed and to make recommendations for the elimination of inefficiencies at all levels. Participants suggested that it was imperative for Saint Lucians to begin to appreciate the paradigm that health care must be viewed as a joint responsibility between the Government and the consumer. Governments ability to pay for all health services must be complimented with options such as: National Health Insurance and fee for service. The group examined the need for greater collaboration and regulation between the public and private sector.
Continuous Quality Improvement is viewed as a management concept that is fast becoming a strategy to enhance organizational efficiency. This working group has capitalized on this popular concept and has outlined mechanisms that would ensure a sustainable quality health care system. These mechanisms include organizational restructuring, information system management and national regulation. They are all interrelated and help to promote the ultimate goal of standardization within the health care sector.
Health Information was examined according to three specific classifications - selection and planning of programs; determination and monitoring of quality care and, information generation with a view to sensitize and educate the public on pertinent health matters.
With regards to the selection and planning of programs, the group suggested continuous staff development and training in specialized areas such as Health Informatics and Epidemiology. These were seen as essential in acquiring information that is necessary for the maintenance and improvement of the existing health information system. Health information is also essential for virtually every component of the system especially data analysis and
reporting. The group further suggested that a quality care unit be established at the Ministry of Health to monitor and determine quality care. This would take into account functions such as research and development, public relations, marketing and media communication.
The Human Resource Development working group suggested that in order to facilitate any reform process one needs to develop a comprehensive human resource plan based on organizational goals and objectives. Some critical areas which were examined, included: staff training, decentralization of management authority, accountability and modifying organizational behavior. These may require management reform at every institution if they are to be successfully tackled in the work environment. Thus institutional change akin with its surrounding management methods are paramount to engendering any effective reform process.
The National Health Service working group discussions were centered on creating a suitable framework within which to orient a National Health Service Plan. This was augmented with the need for goal setting amongst key stakeholders in the planning process in order to develop and implement effective Health Service Plans. From the discussions it was recognized that Primary Care has been of a relatively good quality and that it needs to be built upon. Moreover, Primary Care has been seen as the most cost-effective way of providing quality service to our population. The group further stressed that Primary Care can not survive on its own but must be integrated with Secondary and Tertiary Care. This integration process can be achieved by implementing a referral system between the various levels of care.
The composition of the group on Health Administration weighed heavily in favor of health professionals but more specifically administrators. The aim of the group discussions was to review the challenges affecting the Public Sectors Health Service administration and to provide directives and strategic approaches for the way forward in the context of Health Sector Reform. The group identified the inherent strengths and weaknesses of the health sector and the relative impact of the environment external to the Ministry of Health. One of the definite strengths was the availability of health care personnel who are willing to take on responsibility. Some of the factors of the external environment included public perception, mass media, lack of finance and the inadequate training of personnel.
There was a general agreement that the systems of administration of health services were inefficient in that they lack effective incentives and sanctioning measures. The system has been further identified as inflexible and over-centralized. Also of concern was the disparity in occupancy/utilization rates between hospitals and individual departments, the apparent lack of priority given to human resources and facilities development and the ubiquitous lack of authority and accountability. Further, there was a general lack of enforcement of standards to complement these aforementioned priority areas.
The way forward is difficult and demands strong political will, bi-partisan support, total national mobilization, restructuring and allocation of considerable human and financial resources for successful implementation. Due to the nature and extent of the reform process it must start now. It must also be a feature of high priority on the Governments agenda.
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