1. Eastern Caribbean Countries Health System and Private Sector Assessments 2011 Lisa Tarantino USAID’s Health Systems 20/20 Caribbean & Strengthening Health Outcomes through the Private Sector Projects October 25, 2012

2. Leveraging USG resources for health systems strengthening U.S.-Caribbean PEPFAR Partnership Framework aims to increase HIV program sustainability by: Supporting health system financial reforms Strengthening and expanding public/private partnerships PEPFAR II emphasizes health systems strengthening to improve sustainability of HIV response Emergence of HIV as chronic disease mandates sustained, integrated response Requires strong overall health system, including sustainable financing 2

3. Participating Countries 1. Antigua and Barbuda 2. Dominica 3. Grenada 4. Jamaica* 5. St. Kitts and Nevis 6. St. Lucia 7. St. Vincent and the Grenadines 3

4. Improve sustainability of systems and HIV/AIDS programming Describe pressing health issues and system challenges according to the WHO building blocks Understand current and potential private sector contributions Develop recommendations and action plans Conducted in 2011 by: USAID’s SHOPS & HS 20/20 Projects; PAHO; i-TECH and CHART with Ministries of Health / National AIDS Programs Health System Assessment Approach (www.healthsystemassessment.com) 4 Objectives & Methodology

5. Common findings: Governance Media has a public information service and a watchdog function Uneven and sometimes inadequate reporting impacts accountability Strategic planning needs Significant gaps in legislation and regulation of the health sector Limited ability of private health sector to provide input into policy and planning 5

6. Health Financing Public services available without significant financial barriers, especially at the PHC level Lack of available data on what existing service commitments really cost or projections on funding growth in future No information on out-of-pocket spending, or spending in the private sector In places there is a danger that tertiary care commitments will erode the primary care system Health financing sustainability is an issue, especially for HIV 6

7. HRH & Pharmaceuticals 7 Human Resources High levels of competence & dedication Adequate number of health workers across most (but not all) cadres; shortages of some specializations Need improved HRH policies & planning Need for better understanding of private sector human resources In some countries, HIV expertise is limited to small number of providers Pharmaceuticals & Medical Products Good access to quality pharmaceuticals Collaborative relationship with PPS but serious concerns about future Insufficient monitoring/regulation especially in the private sector Pharmaceutical management systems need strengthening

8. HIS & Service Delivery HIS Established routine data collection and reporting processes & surveillance systems Uneven reporting from private facilities Separate data collection and processing systems for HIV vs. other health data Service Delivery Strong primary care, some specialized care is available Adequate number of facilities Quality assurance systems needed Gaps in referral processes between sectors and levels of care Centralized HIV/AIDS treatment

9. Recommendations 1. Prepare population, leadership for sustainability challenges, and build political will for change (may need to limit services, add fees, taxes, etc.?) 2. Invest in financial analysis (costing, NHA) and strategic planning, particularly to sustain HIV/AIDS services 3. Prioritize updates of key legislation and policies 4. Improve efficiency and quality at all levels of care (strengthen referral system, collect and use data from public and private sector) 5. Build on existing informal cooperation between the public and private sectors to sustain HIV responses

10. Where we went from there Action planning with countries Supporting action plans to sustain national HIV responses through: Identifying private sector health resources and leveraging contributions Building stronger health financing capacity

11. Engaging the Private Sector 11

12. Engaging the Private Sector 1. Private sector mapping Antigua and Barbuda Dominica St. Kitts and Nevis St. Vincent & the Grenadines 2. Public-Private Forums Antigua and Barbuda Dominica St. Kitts and Nevis Identified Private Providers Antigua & Barbuda Dominica St. Kitts & Nevis St. Vincent & the Grenadines Totals Physicians43323550 161 Dentists137814 42 Private Hospital/Imaging Centers 233 6 Laboratories6 113 10 Pharmacies159716 47 Nursing Homes5 2 7 NGOs providing HIV and/or reproductive health services 8955 27 Professional Associations 4313 11 Totals94615998 312

13. Engaging the Private Sector 3. HIV NGO Strengthening (2-3 countries to be determined) 4. Improving information sharing and reporting Dominica mHealth pilot (with replication in another country) Antigua and Barbuda 5. Private insurance industry scan (Grenada) 6. Regional meeting to foster national and regional partnerships 7. On-line Community of Practice for public-private engagement 13

14. Strengthening Health Financing 1. Costing services for better decision-making and resource allocation Antigua and Barbuda – exploring integration of HIV/AIDS services into PHC St. Lucia 2. National Health Accounts, including HIV sub-accounts: Dominica St. Vincent and the Grenadines St. Kitts and Nevis Barbados (introduction) 14

15. NHA describes and quantifies the flow of health funds 15 A methodology that systematically captures and compiles all health expenditures in a health system NHA tracks every health dollar from the original source through the financing agent, to the provider, and finally to the health service where it is spent Internationally accepted and tested (100+ countries) Providers Functions Financing Source Financing Agent

16. NHA contributes to health policy Can lead to better informed health policy decisions and avoid potentially adverse policy choices What is the burden of financing on households? What is the dependency for financing on donors? Who has programmatic control over resource allocation to providers? Are funds being spent in accordance with national strategic plans? How much is being spent on off-island care? Intended for all health stakeholders: Government, Donors, Employers, Civil Society, etc. 16

17. Strengthening Health Financing 3. Strengthening financial data reporting, analysis, and use for decision-making St. Lucia Antigua and Barbuda 4. Support National Health Insurance Development Grenada (policy options) 17

18. Thank you! 18 Lisa Tarantino USAID’s Health Systems 20/20 Caribbean & Strengthening Health Outcomes through the Private Sector Projects Lisa_Tarantino@abtassoc.com