1. Belize, May31,2006 Health Systems Strengthening Seminar Monitoring Health Systems Change/Health Reforms Service provision Dr J. Gernay

2. Belize, May31,2006 Objective To describe and analyze the strengths and weaknesses of the health system’s organization and structure, which serve as the foundation for Health services provision.

3. Belize, May31,2006 Service provision 1. Supply and demand of health services 2. Human resources development 3. Medicines and other health products 4. equipment and technology 5. Quality assurance

4. Belize, May31,2006 1. Supply and demand for health services SUPPLY Services designed to promote, prevent, recover,& rehabilitate the health of a target population (individual and collective level) ( facilities, complexity level, bed count...)Table 17 DEMAND Explicit request for health services Utilization expresses the demand that was satisfied with regard to a target population in a given period. (use of health services at PHC and SHC level…) Table 16

5. Belize, May31,2006 1. Supply and demand for health services Identification of gaps in health care Determination of problem areas Recommendations for policies, plans and programmes

6. Belize, May31,2006 2. Human Resources Development 1. Training 2. HR Management and working conditions 3. Supply and distribution (labor market) 4. Governance and sectoral conflict

7. Belize, May31,2006 2. Human Resources Development TRAINING How many HR Health/pop? How fast are they produced? Adapted to the population needs? # schools? Specialists vs. generalists? Frequency of review of curricula?

8. Belize, May31,2006 2. Human Resources Development HR MANAGEMENT Reform processes result in: New institutional organization (self managed hospitals) New labor relations ( outsourcing) -----new : contracts, changes in career, job security, incentives Research? Employment distribution public/private/ geographically? Income : qualification Reclassification? Outsourcing?

9. Belize, May31,2006 2. Human Resources Development SUPPLY & DISTRIBUTION OF HR Quantity by: –Profession –Sex –Public/private sector –Geographical region Table 18,19 Professional migration?

10. Belize, May31,2006 2. Human Resources Development GOVERNANCE AND CONFLICT IN HEALTH SECTOR Organization of health workers ( associations, unions) Power restructuring with decentralization/ unequal implementation ------- Resistance to change / conflicts/ slow implementation Capacity for conflict management? Policy consensus? Participatory management?

11. Belize, May31,2006 3. Medicines & other Health products High health expenditures Economic importance of sectors involved in research, development, production, distribution& dispensing ? Roles of private/ public sector Essential medicines observatory, policy, regulatory processes, national list (VEN)? Treatment protocols? Obligatory pharmacist presence? Table 20

12. Belize, May31,2006 4. Equipment & technology Table 21 availability of equipment % defective/ out of use % of budget for maintenance?

13. Belize, May31,2006 5. Quality assurance Basic health care standards? QA programmes? Accreditation criteria,procedure & entity? Complaint mechanisms? Measurement of H. Services performance vs. established Quality standards? Standards: HR, $, inputs, technology, monitoring frequency?