1.1 BACKGROUND TO HEALTH SECTOR REFORM
It is an accepted truism that Health Sector Reform is fundamental to the sustained economic and social advancement of a nation. An improved health system will contribute directly to the improvement and expansion of the human resource potential on the island. In recognition of this fact, the Government of Saint Lucia has pledged its unrelenting support and commitment to the reformation of the health sector.
The need for Health Sector Reform stems from major inadequacies in the organization, management, financing and provision of health care services. This is primarily due to the fact that historically, in Saint Lucia, the government has played the principal role in all three essential functions of the health system, namely: policy development and regulation, service provision and financing. The governments ability to perform these functions satisfactorily is influenced by economic constraints, changing demographic and epidemiological profiles of the population, increased expectations of users and providers of health care, availability of trained personnel and committed staff members. It is becoming extremely difficult for government to function as it presently does and to ensure acceptable standards of health care for all, particularly in catering for the most disadvantaged groups. The reasons for this have been cited as increasing health care costs, increases in the population dependency ratio and declines in economic gains from major income generating sectors.
The recognition of financial constraints in the face of increasing public demands for better health care services, particularly the case of Victoria Hospital, has prompted several actions towards reform at the national level. In response, the Minister of Health, Human Services, Family Affairs and Women requested the formation of a Health Sector Reform Committee, charged with the responsibility of assisting the Ministry of Health in the preparation of a policy paper on health. This policy paper when produced is intended to guide the actions of the Ministry as it seeks to provide quality service.
As part of a vision for the reformation of the health sector, the Health Sector Reform Committee prepared a document, "Consultation Health Sector Reform". This document analyzed three main areas of concern within the health sector efficiency, equity and efficacy and summarized concepts and suggestions. The issues raised in that document were reviewed by PAHO Consultant, Dr. Kenwyn Nicholls.
One of the major suggestions coming out of the Health Sector Reform Committee (HSRC) document was the establishment of a Health Sector Reform Secretariat to execute the work of the HSRC. The Secretariat comprises seven individuals: the Chief Medical Officer, the Chairperson of the Health Sector Reform Committee, a Health Educator, an Environmental Officer, a Public Relations Officer, a Sociologist, and an Health Services Administrator. These individuals, in collaboration with the Ministry of Health are responsible, for the planning and coordination of the Health Sector Reform process.
The first task undertaken by the Secretariat was the preparation of a summary document, "Health Sector Reform Summary Document". This document aimed to inform the stakeholders of the rationale behind the consultation and the Health Sector Reform process, to provide a summary of the activities of the Health Sector Reform Committee and to educate the stakeholders on some crucial concepts and issues of Health Sector Reform.
The second major task was the creation of seven working papers, for the purpose of small working group discussions. The working papers addressed critical areas of concern within the health care system. The participants were grouped according to their roles in respect of the health service sector. This particular method of selection was employed to facilitate the orderly movement of participants into working groups and to ensure that each working group was equipped with the appropriate human resource mix.
Titles of working papers
Each working paper was divided into four sub-sections:
The contents of the working papers were developed after consultation with the three major reference documents. These documents were: Consultation Health Sector Reform (HSRC), Review of the draft document on Health Sector Reform (PAHO - consultant) and A descriptive analysis of the strengths and weaknesses of the health care system in Saint Lucia (the HERA Document). Each working paper provided a focus for group discussions around major health concerns, which would guide the governments action plan.
One of the first major activities undertaken to officially launch this new initiative was a national consultation on Health Sector Reform on July 31 and August 1, 1998, under the theme Guaranteeing Quality Health Care. This event marked a turning point in the history of the health planning process in Saint Lucia. It opened the doors to a participatory approach to health planning which will give the citizens of Saint Lucia an opportunity to contribute openly to the improvement of the health care system. The objectives of this consultation were:
To educate, sensitize and develop awareness of Health Sector Reform issues
To stimulate discussion and seek feedback from stakeholders
To build and strengthen partnerships in the Health Sector Reform process
This White Paper will present recommendations for the development of improved health services and systems, and will reflect the concerns of users and providers of health care in Saint Lucia.
THE PREPARATORY MEETING THE FIRST CONSULTATION
The first national consultation took the form of a two-day workshop at The Caribbees Hotel. The ceremony commenced with a compelling rendition of the national anthem, followed by prayers. The Permanent Secretary of the Ministry (chairperson of the meeting) welcomed everyone followed by speeches from the Deputy Prime Minister, the Minister of Health, Human Services, Family Affairs and Women and a member of the Health Sector Reform Committee.
The opening speeches contributed to an understanding of the purpose for the consultation and the need for Health Sector Reform in Saint Lucia. The Deputy Prime Minister defined health as a fundamental right of all citizens and the responsibility of a government to its people. The Deputy Prime Minister also pledged governments commitment and continued support to the Reform process.
The Minister of Health, Human Services, Family Affairs and Women described the numerous problems experienced by the health care system in Saint Lucia. She alluded to the need for clear policy direction to inform the restructuring process. The Minister announced that policy direction would be formulated only after extensive consultation with the players in the field of health, stakeholders and the general public (Appendix II).
The lectures that followed outlined the driving forces for Reform in the region (epidemiological, demographic, social, economic and political) and examined some critical areas of concern. The speakers discussed the need to revisit the existing health care model (which has informed the actions of Caribbean Governments with respect to health care provision, organization and management and financing) with a view to improving the health care system.
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