1. The Introduction of National Health Insurance (Universal Health Care) in Saint Lucia Prepared by: Emma Hippolyte, Director, For ISSA meeting - BVI July 2005

2. In March 2005, the Government of Saint Lucia appointed a Task Force to look into the feasibility of introducing the following social programmes in Saint Lucia: National Health Insurance National Health Insurance Unemployment Insurance Unemployment Insurance Pension for Farmers Pension for Farmers

3. The Task Force reported to the Cabinet of Ministers on July 11, 2003.

4. Current status of health Limited control of secondary and tertiary care services Limited control of secondary and tertiary care services Inequitable access to secondary and tertiary care services Inequitable access to secondary and tertiary care services Poorly defined agreements and expectations with health professionals Poorly defined agreements and expectations with health professionals

5. Current status of health (cont.) Poor communication and frustration between Ministry of Health and health providers and between providers and between staff and the general public Poor communication and frustration between Ministry of Health and health providers and between providers and between staff and the general public Poor accountability, limited responsibility Poor accountability, limited responsibility

6. Poor organization and coordination Poor organization and coordination Pressure from new health infrastructure (to be constructed) Pressure from new health infrastructure (to be constructed) Poor quality of health care delivered by some providers Poor quality of health care delivered by some providers The call for improved quality of health care by the public. The call for improved quality of health care by the public. High migration of nurses High migration of nurses Current Status of Health (cont.)

7. Methodology (process) The Task Force appointed eight (8) committees to assist in the process of preparing and implementing the UHC Programme. These include: Registration Committee Registration Committee Human Resource Training and Development Committee Human Resource Training and Development Committee Essential Package of Services Committee Essential Package of Services Committee

8. Quality Assurance Committee Quality Assurance Committee Health Information and Management Committee Health Information and Management Committee Legislation Committee Legislation Committee Public Education and Marketing Committee Public Education and Marketing Committee Pharmacy and Therapeutics Committee Pharmacy and Therapeutics Committee Methodology (process)…(cont.)

9. The Cabinet of Ministers endorsed the report on August 11, 2003 and mandated the NIC to take steps to implement the programme. The Cabinet of Ministers endorsed the report on August 11, 2003 and mandated the NIC to take steps to implement the programme. Methodology (process)…(cont.)

10. Prior to preparing the report the Task Force held discussions on the features of the programme with key stakeholders viz: Prior to preparing the report the Task Force held discussions on the features of the programme with key stakeholders viz: Nurses Nurses The Insurance Council The Insurance Council The Trade Unions The Trade Unions Employers Representatives Employers Representatives The Pharmacy Council. The Pharmacy Council. Methodology (process)…(cont.)

11. The Task Force visited the Barbados Drug Service, NIS of Belize and the Antigua Medical Benefits Scheme. The Task Force visited the Barbados Drug Service, NIS of Belize and the Antigua Medical Benefits Scheme. Methodology (process)…(cont.)

12. Communications/Public education During the period, November 2004 and February 2005, a two (2) person team of Ms. Emma Hippolyte and Dr. Stephen King conducted discussions with communities around the island. To date the team has met with ten (10) communities. During the period, November 2004 and February 2005, a two (2) person team of Ms. Emma Hippolyte and Dr. Stephen King conducted discussions with communities around the island. To date the team has met with ten (10) communities.

13. NIS Belize shared documents on their system. NIS Belize shared documents on their system. Dr. Figueroa of Belize visited Saint Lucia to share their experience. Dr. Figueroa of Belize visited Saint Lucia to share their experience. Communications/Public education (cont.)

14. The public broadly expressed concern about the quality of care and the equity of care in the health delivery system. They wanted assurance that the UHC system would improve the quality of care. Communications/Public education (cont.)

15. A web site www.stluciauhc.org which encourages persons to send emails with their opinion was established with the following features: Welcome About UHC About UHC Reports Reports Communications/Public education (cont.)

16. FAQ FAQ Committees Committees News News Consultancies Consultancies Job opportunities Job opportunities Forms Forms Links Links Contact us Contact us Communications/Public education (cont.)

17. The UHC product Hospital based services including inpatient and outpatient care, diagnostic services, pre- hospital and hospital emergency care and inpatient pharmacy services. Mental health services including substance abuse rehabilitation Mental health services including substance abuse rehabilitation Outpatient pharmaceuticals Outpatient pharmaceuticals Overseas care Overseas care

18. Community services (in the second phase) Community services (in the second phase) Local service development Local service development Limited package in all areas Limited package in all areas The joint purchasing of drugs and medical supplies by public and private providers The joint purchasing of drugs and medical supplies by public and private providers Financing mechanism: Financing mechanism: Flat tax: health and environmental levy on imports (excluding food and clothing) to gross approximately XCD30m annually. Flat tax: health and environmental levy on imports (excluding food and clothing) to gross approximately XCD30m annually. The UHC product (cont.)

19. Execution/Administration Four consultancies are in progress:- Risk Management and Quality Assurance Assessment Risk Management and Quality Assurance Assessment Human Resource Human Resource Legislative Review Legislative Review Health Information and Management System (HIMS) Health Information and Management System (HIMS)

20. Risk Management and Quality Assurance Assessment Objective: Objective: To assess the status of the five providers and to present a road map for international accreditation. To assess the status of the five providers and to present a road map for international accreditation. To improve the quality of health service in the country. To improve the quality of health service in the country. Execution/Administration (cont.)

21. Human resource The consulting firm of Odyssey Consulting was appointed in August 2004 to prepare a Human Resource and Training Strategic plan for the entire health sector. Execution/Administration (cont.)

22. Legislative review A legislative draftsman was appointed in October 2004 to review existing legislation and to make recommendations. Execution/Administration (cont.)

23. Determine the most cost effective design, implementation and support for an integrated system health information system that is capable of responding to the requirements of the health sector. Health Information and Management System (HIMS)

24. To ensure a seamless flow of information between primary care and secondary care To ensure a seamless flow of information between primary care and secondary care The protection of data from unauthorised use The protection of data from unauthorised use The use of a single identification card or more than one card. The use of a single identification card or more than one card. THE CHALLENGES

25. Governance: Providers The task force identified the rectification of the governance of Victoria Hospital as a crucial pre- requisite for improvement to quality care.

26. Governance – UHC Governance of UHC has been an issue of intense discussion. Propose an amended NIC Board.

27. The challenges that we are currently working on follows: The amendments to the current NIC Structure to accommodate the UHC. The amendments to the current NIC Structure to accommodate the UHC. Identifying the right skills set to get the job done. Identifying the right skills set to get the job done. Socio Economic Impact Assessment now underway – to be completed in June 2005. Socio Economic Impact Assessment now underway – to be completed in June 2005. Governance – UHC (cont.)

28. Implementing the change processes at the provider level. Implementing the change processes at the provider level. Managing public expectation – they want immediate solutions. Managing public expectation – they want immediate solutions. Governance – UHC (Cont.)

29. Other outputs/Outcomes Registration Committee: A report on method of registration has been received from the Committee. This however has to fit into the work of the HIMS Committee.

30. Essential Package of Services Committee: The Committee has developed a Draft Essential Package of Services – This was sent to the Saint Lucia Dental and Medical Association and the Nurses Association for their comments. Thereafter to the Insurance Council for their consideration and amendments of their private Health Insurance Plans. Other outputs/Outcomes (cont.)

31. Pharmacy and Therapeutics Committee This Committee has developed a Drug formulary for the country. This will be circulated to the Saint Lucia Dental and Medical Association, the Saint Lucia Nurses Association and the Pharmacy Association. Other outputs/Outcomes (cont.)

32. The Work Continues… Thank You