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What Services Will UHC Provide? - April 24, 2006

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What Services Will UHC Provide?


Today, I have decided to return to the establishment of the Universal Health Care System. I want to focus on the services which will become available to all Saint Lucians. In other words, what would Saint Lucians be entitled to receive?. What are they guaranteed under the UHC?


Let us start with the hospitals. We have agreed that all the existing hospital services provided at Saint Jude Hospital and Victoria Hospital will be included. New services will be included as they develop and the agreements will be adjusted as necessary, annually. Private Hospitals can be UHC providers. They will be required to operate on the same terms and conditions as Victoria Hospital and Saint Jude Hospital. No resident of this country registered with UHC will have to pay anything at the time of service delivery. However, persons must use the hospital that they are registered with. The only exception is for emergency services, in which case, the person goes to the closest facility to where the emergency occurred.


The UHC has developed a list of medications. We will fund medications and dispense them to residents at no charge at the point of service.

The pharmaceutical package will be phased in over the next two years. It will start with the most critical diseases requiring medication, for example diabetes and hypertension. It will rapidly be expanded as the UHC unfolds to include medications for many other diseases including cancer, infections including HIV/AIDS, asthma, pain medication and others.

UHC medications will be available in all public pharmacies including Saint Jude Hospital and Victoria Hospital. Private pharmacies will be included after the pilot project. They will operate in a similar fashion to the pharmacies in Barbados. In this system, the private pharmacies are paid by UHC per prescription to dispense UHC medications.


We have included mental health services in the UHC package. We are anxious that these services benefit from the new UHC system which not only provides adequate financing matched to levels of service expected but also drives quality improvement in the health services.


We have recognised the desperate situation in Saint Lucia with alcohol, crack and marijuana abuse. We cannot afford to maintain financial barriers to rehabilitation services. Thus, we will fund these services as part of the UHC. Persons who are victims of substance abuse will have unrestricted access to rehabilitation.


There are some services that are necessary but not available in our general hospitals. We intend to fund these services such that all residents can have access without having to find the money. We will enter into service agreements through a tender process for the defined special services with the selected providers, overseas or local. The types of services that will be covered include, cancer care especially radiotherapy, cardiac surgery, neurosurgery, neuromuscular services, specialised eye surgery and special diagnostics like CT and MRI scans.


The UHC will have a special fund for local services development and research. This is built in to facilitate the development of new services.


The UHC will hold for the hospitals a portion of the UHC fund earmarked to cover depreciation of plant and equipment. This equity fund will be invested in short and long term investments. The fund will be used to replace equipment and will also be available in the long term to replace our hospital infrastructure. We are unlikely to be so fortunate in the future to have two new hospitals donated to us. This equity fund guarantees that we will not have to borrow or get grant funding for hospital maintenance.


The UHC will have a contingency fund that is invested and held in reserve to help it respond to economic shocks.


The objectives outlined for the Universal Health Care System are:

  1. The overriding objective is to provide universal access to necessary services.

  2. Objectives number two is to improve the quality of health services.
    This will be done through the implementation of a national quality system and hospital specific quality plans. The UHC is demanding that each hospital be enrolled in an accreditation programme. This is a system in which professional bodies from outside Saint Lucia conduct quality assessments of hospitals and award accreditation if the hospital meets the set standards. Through the UHC every hospital in Saint Lucia has already been assessed by the Canadian Council for Health Services Accreditation. Every hospital has been given a report and is being supported to develop their quality plan to address the identified deficiencies. This year we intend to embark on a four year programme designed to achieve international accreditation for every UHC participating hospital.

  3. The third objective is to improve prove productivity and efficiency.
    The Government hospitals will be statutorised in the UHC system. This means that each hospital will be managed by a Board. Every hospital will be operating on a level playing field; they will all be operating under the same terms and conditions. Within the UHC service agreements the hospitals retain all surpluses or on the other hand they have to absorb all losses. The hospitals will be responsible for all their resources and will have the flexibility to be creative. This is designed to encourage productivity and efficiency.

  4. The fourth objective is cost containment.
    The system of funding proposed for the hospitals is called capitation. This system is easy to administer and encourages cost-containment. We know that our administrative systems are not robust and well developed, hence one of the reasons for adopting this system of financing. The hospitals receive an agreed budget for the agreed set of services, no more no less.

  5. The fifth objective is to ensure the sustainability of the UHC. This will be done by strengthening the capacity of UHC to respond to shocks of whatever kind.

  6. The sixth objective is to harmonise the public and private sectors in the delivery of health services.

  7. The seventh and final objective is to develop local health services.




One question which may concern you is this: How will the UHC be integrated with the Health System as a whole? The Health Strategic Plan 2006-2011 address four components of the Health Sector:


  1. The first component is the Central Agency. This is the Ministry of Health, Human Services and Family Affairs head office. It is responsible for regulation. It is responsible for coordination and advocacy both within and outside the Health Sector. It also provides the central intelligence and planning functions for the entire health sector. The Central Agency regulates through licensing all UHC providers. The Central Agency also works with UHC to negotiate with providers for service agreements. The Central Agency houses the national quality system and monitors the health sector including UHC provider performance. The Consolidated Fund tranche for the UHC is administered through this Central Agency.

  2. The second component is the Priority Health Areas identified for treatment. These are:

    1. Communicable diseases;

    2. Non-communicable disease;

    3. Sexual and Reproductive health;

    4. Child and Adolescent health;

    5. Environmental health;

    6. Oral Health;

    7. Emergency Medical Services;

    8. Mental Health and Substance abuse;

    9. Food and Nutrition;

    10. Violence and Injuries;

    11. Eye-Health and Disabilities; and

    12. Social Protection.

  3. There are clear plans with strategies, activities and targets to adequately address the diseases and the populations identified. These areas will be guided by multisectoral national teams but will have an identified accountable programme head. These programmes will also facilitate non-Governmental and public participation in the planning and delivery of services in these areas.

    An example of one of the programmes in the Priority Health Areas is our recently launched and ongoing HIV/AIDS programme. This programme is guided by a multisectoral council of which I serve as the Chairman.

    These priority programmes create clear focus and ensure the national co-ordination of effective interventions. They will guide activities in UHC services and Regional Health Services.

  4. The Regional Health Services.
    The third component is the Regional Health services.  These include all our community health services and facilities. There will be nine regional health teams responsible for their respective populations in each region. These teams will be multidisplinary and multisectoral. They will allow health workers and the public to interact in the planning and delivery of services at the health centres, polyclinics and district hospitals. These services will work with UHC services to dispense pharmaceuticals, to identify and refer persons requiring UHC services and to receive from UHC persons on discharge for rehabilitation and convalescence.



Where are we now? Are we close to implementation? We have almost reached the point of launch for the UHC. This financial year is our pilot and preparatory year. We will pilot the pharmaceutical component with the diabetes and hypertension programme. We will pilot the new health information system. We will commence the quality improvement plans at each hospital on the road to accreditation. We will start the implementation of the Health Strategic Plan. In this year, we will invest in the Regional Health Services and the Priority Health Areas to ensure that the community services and the disease management systems and mechanisms are in place before UHC launches. We are presently implementing the National Emergency Medical Services.

We will improve the regulatory environment to give the Ministry the capacity to effectively regulate the health services. A new Health Practitioners, Bill which will introduce licensing for all health professionals, will be enacted this year. The hospitals will be stautorised and the UHC legislation will be passed. We need to do the necessary final preparatory work and pilot components of the UHC this year. The pilot programmes are being done because we are prudent. We have done the best planning and the best designs. However, we need to “road test” some of these programmes. We intend to learn lessons and modify if necessary to guarantee success when the full UHC launches.


Fellow Saint Lucians, our country is at a delicate and critical time in its history. We cannot afford any mistakes. Our future, the future of our young people, the future of Saint Lucia will be determined by the decisions and actions we take now. I believe that a nation that does not develop the systems of care for its people is one that is doomed to social disharmony, crime and retarded development. Many of the problems facing us are rooted in the legacy of years of neglect. This is a legacy that I want to change. I want to leave a new and hopeful legacy, one of a caring society. Sometimes, like you, I have been frustrated at the slow pace of change; however major progress is being made. We need only think of Universal Education and Universal Health Care to see the clear intent of this SLP Government. I firmly believe that it is through Education and Health that a people truly develop and leave poverty behind. I urge you to have faith, to be bold, be strong. You have the ability to think and analyse for yourself. You must do so. The UHC and the Health System is important for all of us. Do your part to make it a reality; I will continue to do mine.

God bless, take care, and watch out for the Budget Address tomorrow, Tuesday.


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