Health Sector Reform in Trinidad and Tobago Overview, Issues & Challenges.

Historical Review Julien Commission, 1957 National Advisory council, interim Report, 1978 Toby Commission Report, 1982

Health Sector Reform Program IADB Funded

Goal of HSRP To improve the health status of the population by promoting and providing affordable quality health care in an efficient and equitable manner. This goal is supported by five (5) specific objectives:

Objectives Strengthening the policy-making, planning and management capacity of the health sector; Separating the provision of services from financing and regulatory responsibilities; Shifting public expenditures and influencing the redirection of private expenditures to high priority problems and cost-effective solutions; Establishing new administrative and employment structures, which encourage accountability, increase autonomy and appropriate incentives to improve productivity and efficiency; Educing preventable morbidity and mortality through promoting lifestyle changes and other social interventions.

Milestones 1989 – 1992: Eight IADB missions 1992: Government’s decision to introduce HSR 1993: Two teams of consultants and local counterparts established 1994: A comprehensive Final Report with 40 Annexes prepared outlining i) proposed models for improvements ii) human resource requirements iii) estimated costs iv) strategy for the way forward [National Health Services Plan] 1994: Development of White Paper and creation of the RHA Act.

Features of the NHSP The Plan’s strategic intent was to guide the MoH in: Achieving significant shifts in resources; Reducing bed numbers; Introducing specialist services; Introducing new technology; Introducing new management and operating systems; Delivering new services based on need; and Effectively work with provider agencies.

Critical Success Factor The strategies embodied in the NHSP reflected significant changes from the old order. A large-scale program of Technical Assistance, that would provide the necessary institutional strengthening support to the MoH and the RHAs, was therefore critical to the success of the HSRP.

Key Technical Requirements Human Resource and Change Management Strategies (Transition Plan); RHA Management Systems and Protocols; Quality Management; Need Assessment (National Disease Surveillance system); Health System Information Strategy Health Financing Strategy

Human Resource Management Achievements Challenges Creation of six (6) core Directorates: • Health Services Quality Management • Health Policy, and Planning •Health Promotion, and Communication • Finance and Projects •Human Resources • Information Systems Dual track employment (MOH and RHA staff) Limited capacity at RHA and MoH to undertake new roles

RHA Management Systems Achievements Challenges Decentralised decision making Accountability Measures such as Business Plans, MoH Purchasing Intentions and Annual Services Agreements not implemented. Reductions in operation costs through bulk Purchasing

Health Services Quality Management Achievements Challenges Report on Regulating Health care Quality finalised by Quality Management Legal expert Following key areas still absent: • Risk Management Policy Framework • Health Technology Assessment policy and guidelines • Inventory Management and • Review of Medical Record Policy and Procedures Health Services Accreditation Manual for T&T, approved and distributed to stakeholders Health Services Quality Council operational

Health Needs Assessment Achievements Challenges Baseline Assessment (Situation Analysis) Completed First nationwide HNA not yet done

Health Information Systems Achievement Challenges Information Technology Strategic Pan including Hardware and software procurement requirements developed. IT strategic Plan revised within last 6 months Original consultancy was not of the required standard and was aborted Delays in attracting a new National IT Director The Public sector’s Information backbone (platform) not yet available

Health Financing Achievements Challenges New Technical Secretariat to spearhead alternative financing for the sector implemented within last year Numerous aborted attempts at new financing strategies have led to stakeholders’ scepticism

Conclusion HSR objectives were on target. HSRP design for achieving health system improvement was sound The soft components (technical know how) to effect the sector’s full transformation lagged because among other things: The general Public Sector Reform process was slow There was limited absorptive capacity at the MoH and RHAs