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

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

3. Health Sector Reform Program IADB Funded

4. 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:

5. 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.

6. 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.

7. 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.

8. 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.

9. 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

10. 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

11. 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

12. 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

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

14. 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

15. 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

16. 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