What Services Will UHC Provide?
INTRODUCTION
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?
LOCAL HOSPITAL SERVICES
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.
PHARMACEUTICALS
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.
MENTAL HEALTH SERVICES
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.
SUBSTANCE ABUSE 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.
SPECIAL SERVICES INCLUDING OVERSEAS CARE
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.
LOCAL HEALTH SERVICE DEVELOPMENT
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 NATIONAL EQUITY FUND
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.
CONTINGENCY FUND
The UHC will have a contingency fund that is invested and held in reserve to
help it respond to economic shocks.
OBJECTIVES OF UHC
The objectives outlined for the Universal Health Care System are:
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The
overriding objective is to provide universal access to necessary services.
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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.
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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.
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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.
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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.
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The sixth
objective is to harmonise the public and private sectors in the delivery of
health services.
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The seventh
and final objective is to develop local health services.
HOW IS UHC
INTEGRATED WITH THE HEALTH SYSTEM?
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:
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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.
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The second
component is the Priority Health Areas identified for treatment. These are:
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Communicable diseases;
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Non-communicable disease;
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Sexual and
Reproductive health;
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Child and
Adolescent health;
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Environmental health;
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Oral
Health;
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Emergency
Medical Services;
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Mental
Health and Substance abuse;
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Food and
Nutrition;
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Violence
and Injuries;
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Eye-Health
and Disabilities; and
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Social
Protection.
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.
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?
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.
CONCLUSION: CANNOT AFFORD MISTAKES
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.
