Palestinian Health Sector Reform And Development Project “The Flagship Project” The Palestinian Health Conference “Toward Quality and Sustainable Health Services” May 7-8, 2009 Presentation on Health System Reform Findings and Comprehensive Priority Response The Institutional Development Plan (I. D. Plan)

Health System Assessment Process MoH/Flagship utilized USAID Health Systems Assessment Approach tool and adapted it to the Palestinian setting. MoH established six technical working groups within the MoH to conduct the assessment with technical and administrative support from the Flagship Project team. MoH/Flagship conducted the assessment to ensure Palestinian ownership of the assessment, buy-in for recommendations, and sustainability in reforms. MoH technical working groups presented their findings and strategies for action to an audience including the Minister, Deputy Minister, USAID officials, and MoH staff. The assessment report is a compilation of the findings and suggested strategies identified by the MoH.

Health System Elements Assessed Governance Finance Service delivery Human resources Pharmaceutical management Health information system

Governance Strengthen MoH capacity to utilize data in management, planning & informed policy formulation. Establish mechanisms to involve citizens’ participation in health policy formulation and decision-making.

Finance Issue/implement the proposed government health insurance law. Initiate a dialogue with national & international stakeholders to agree on a minimum set of dependable resources over next 5 years to effectively use available limited resources. Allocate more resources to preventive & Primary Health Care to reduce costs for delayed care. Support initiatives demonstrating corporate social responsibility for public/private partnerships. Maintain rigorous criteria & guidelines for prioritizing referral treatment. Develop capacity within MoH to be strategic in procurement of drugs, equipment, and supplies.

Health Service Delivery (1) Standardize administrative and operational policies and procedures to respond to patients’ needs. Establish mechanisms to receive and respond to feedback from patients about quality of care received. Review, upgrade, and improve functioning of PHC clinics to respond to needs of patients. Establish & implement strengthened referral & discharge follow up systems.

Health Service Delivery (2) Review PHC programs to focus on pregnant women with anemia & reproductive health care needs of post-menopausal women. Install medical waste management systems & personnel safety procedures. Establish an integrated Quality Improvement Program for delivery of hospital & PHC services. Respond to MoH needs in infrastructure, renovation, furniture and equipment.

Human Resources Update, standardize & enforce Palestinian standards to: 1.License/relicense and certify health professionals and health workers. 2. License and accredit health facilities. Update recruitment, hiring, transfer, promotion & deployment regulations & procedures. Provide supervisors with training on supportive supervision & managing staff performance. Develop continuous education programs for all health professionals including residency programs & encourage health staff to participate & reward them for participation. Initiate ongoing leadership training for managers.

Pharmaceutical Management Issue pharmaceutical procurement law; write, & implement supporting regulations. Adopt & implement a drug procurement plan to include efficient mechanisms for drug pricing, quality assurance & distribution, and encourages national pharmaceutical production.

Health Information Systems (HIS) Install computerized information system with networking inside & between hospitals with central management unit at MoH. Develop/install HIS to manage: patient registration, admission, appointments, care received, referral & follow-up. Develop & maintain an effective HR data base.

MoH Response to Health Assessment Priority Areas for Reform and Intervention Based on assessment findings, MoH developed its 5-year Institutional Development Plan (IDP)/project action plan to provide an implementation framework to institutionalize aspects of health sector reforms.

ID Plan Priority Reform Areas and Interventions Create a Center of Excellence at the Palestine Medical Complex (PMC) Why: An opportunity to demonstrate capacity of MoH to provide quality care to serve needs of Palestinian people in a cost-affordable manner. A package of health reform interventions applied on a small scale at the PMC will serve as a demonstration/model of how to improve clinical services at hospitals and primary health care centers throughout West Bank. Develop a Comprehensive & Integrated Health Information System Why: A cross-cutting issue that affects entire health system. Goes beyond procurement & installation of software & equipment, and builds capacity of MoH to use data for management, planning, & informed policy formulation.

ID Plan Priority Reform Areas and Interventions Implement the New National Health Insurance (NHI) Program Why: An efficient & modern NHI program strengthens MoH capacity to provide quality care and to generate revenues to improve and sustain health programs. Design a Medical Facility Accreditation Program Why: Represents a commitment to quality care by health care institutions through establishing a process to ensure that a facility meets a set of requirements/standards to improve safety and quality of care.

ID Plan Priority Reform Areas and Interventions Create a Relicensing System of Health Professionals Representing all Health Cadres Why: Verifies that the practicing professional workforce is engaged in technically updating their knowledge to provide quality health care. Design a Continuous Education Program to Enable and Support Health Professionals to Continually Update their Knowledge Why: Creates options to enable health professionals to access and update their knowledge and practice to provide quality health care.

ID Plan Priority Reform Areas and Interventions Improve Performance Management Why: Introducing and using new performance management approaches & tools results in more motivated staff with a clear understanding of jobs that they need to do, establishes peer support and supportive supervisory staff to provide quality care. Training and Fellowship Programs in Health Administration and Management Why: Training and system reform requires equipping individuals with new approaches and tools to lead the process of change.

ID Plan Priority Reform Areas and Interventions Improve the Quality of Clinical Emergency, Primary, Secondary and Tertiary Health Care (Modules 11, 12 and 14) Why: Effective and appropriate care at each level results in increased patient satisfaction, better health outcomes, and efficient use of MoH financial resources. Strengthen Service Delivery and Clinical Guidelines Why: Current, evidence-based, user-friendly and available clinical guidelines serve as basis for quality service delivery by trained service providers.

ID Plan Priority Reform Areas and Interventions Improve Medical Waste Management Why: Having specific legislation, regulations, standards, and the authority and capacity to implement effective waste management practices will improve the safety of personnel, patients, and environment. Improve Health Communications and Community-Based Health Services (Modules 13 & 16) Why: Optimal health outcomes can only be achieved through a combination of clinical and community-based interventions that also address knowledge, beliefs, attitudes and skills of the public and health professionals. Influencing behavior and practices assures relevant and responsive health programs, actively mobilizes the participation and resources of the community, and promotes improved health status of the population.

ID Plan Priority Reform Areas and Interventions Support Passing and Implementation of the Health Commodities Procurement Bylaws Why: Need for regulations is one of the tools that allow the MoH to bid and obtain in a timely and cost-effective way all drugs required to respond to the health care needs of the Palestinian people. Introduce & Implement a Comprehensive M& E Approach Why: Putting in place a cross cutting system to improve reporting and communicating results guides planning, decision-making and resource allocation.

ID Plan Priority Reform Areas and Interventions Improve Coordination of Stakeholders Why: Strengthening the capacity of the MoH to coordinate stakeholders ensures that long-term health sector prioritized objectives are addressed, that the regulatory role of the MoH is strengthened, and that there is greater predictability of resources to finance MoH development goals.

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