Anguilla Monitoring Health Systems Change/Health Reform

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Anguilla

• Monitoring Health Systems Change/Health Reform
• Presented by Dr. Bonnie Richardson-Lake

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Background

• Most Northerly of the Leeward Islands
• United Kingdom Overseas Territory
• A Governor appointed by the Queen presides over
  an Executive Council made up of 4 Local
  Government Ministers, the Deputy Governor and the
  Attorney General
• 35 Square miles
• 2001 Census--11,561
• 2003 Population Estimate--12,200

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Economic Activity

• GDP per capita-- EC20,733 or US7,736 in 2003
• Tourism sector makes the largest contribution
  to GDP28
• Government Sector--18.7
• Finance Sector--14.4
• According to the 2001 census 75 of those 15 and
  older were a part of the workforce.

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Health Indicators 2005

• Infant mortality rate 18.0
• No maternal deaths 2001-2005
• Birth Rate 11.4 per 1,000 (2003)
• Male life expectancy--76.52
• Female life expectancy--81.1

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Top Causes of Death (2004)

• Cancer
• Diabetes
• Heart Disease
• Stroke

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Health Care System

• Health care system is comprised of both private
  and public sector
• Public sector health care is delivered by the
  Health Authority of Anguilla
• Primary Health Care is provided in five health
  centres throughout the three health districts

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Primary Health Care

• Health Centres are staffed by
• Physicians
• Pharmacist
• Dentist
• Public Health nurses
• Nurse midwives
• Physiotherapist
• Community health aides
• Clinic aides

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Primary Health Care

• Services provided
• Maternal and Child health
• Family Planning
• Immunization,
• Nutrition advice
• Care of the elderly
• Management of chronic diseases
• Health education.
• Pharmacy Services
• Physiotherapy
• Home Visiting
• General Medical Care
• Community Mental Health

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Secondary Care

• Princess Alexandra Hospital is a 36-bed facility
  which provides
• Emergency treatment
• Surgical Care
• General medical
• Pediatric
• Gynecological and obstetric care
• Laboratory services
• Radiological and Diagnostic services
• Pharmacy services
• Physiotherapy

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Secondary Care

• Long-term Care16 bed senior citizens home
• A 12 bed in-patient psychiatric wing is currently
  under construction and should be commissioned by
  the end of this year
• The unit will provide services to those with
  acute psychiatric illness

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Anguillas Health Care Reform
In 2000 the Government of Anguilla (GoA) took the
decision to place the delivery of health care
services under a semi-autonomous statutory
bodyThe Health Authority of Anguilla (HAA)
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Anguillas Health Reform

• GoA was committed to attaining the most
  productive use of resources and a more timely
  response to the overall requirements of the
  health service.
• One of the main objectives of the reform was to
  attain a greater degree of efficiency in health
  services and an improvement in the delivery of
  quality health care
• Having HAA separate from the Ministry of Health
  (MoH) removed much of the bureaucracy typically
  associated with the general Public Service

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Anguillas Health Reform

• Management responsibilities delegated to the HAA
  included
• Financial
• Human Resource
• Operational Delivery of Health Care Services

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Advantages of a Decentralized Model
The devolution of the health services has several
advantages

• Increased speed and clarity in decision-making
  and implementation
• Health care can best be administered within the
  framework that allows institutions to manage
  their resources (both financial and human)
  directly
• More empowered health officials with greater
  responsibility for the outcome of decisions

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Advantages of a Decentralized Model

• Increased Sustainability
• Improved Equity
• Increased Quality

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Role of the MoH

• After the devolution of the health services to
  the HAA, MoH maintained the following functions
• Policy direction
• Strategic Planning for Health
• Regulatory/licensing functions
• Monitoring Evaluation

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Preparatory Work

• Before the HAA could be commissioned several
  critical activities had to be undertaken. These
  include
• Establishment of a Health Authority Project Board
  to recommend an implementation strategy and later
  the establishment of a Shadow Board
• Governance Structure of the HAA
• Legislative Frameworka bill for the
  establishment of HAA was developed with the
  assistance of an international legal experts

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Preparatory Work

• Development of personnel policies and transition
  arrangements
• Development of financial management systems
• Communication Plan for staff and public
• Development of a National Strategic Plan for
  Health and subsequent service plans
• Development of service agreements and new
  performance measurement systems
• Selecting and training of key managers and Board
  Members

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Preparatory Work
All of the activities were coordinated by
regional consultant funded by DFID
20
HAA
The HAA was commissioned in December 2003 and
became operational in January 2004 under the
Health Authority of Anguilla Act
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Structure of HAA
22
MoH
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Strengthening Health Systems
National Health Fund It is proposed that a
National Health Fund (NHF) is created to purchase
health care for the whole population of Anguilla
as clinically needed and in an equitable manner.
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National Health Fund
The NHF has been based on the guiding principles
of social health insurance which
include solidarity - pooling the financial risk
for the whole population sustainability -
creating an independent funding mechanism able to
match revenue to needs
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NHF
equity - introducing a prospective payment system
removing financial barriers to access efficiency
- avoiding the fragmentation and high overheads
of multiple funding sources effectiveness -
developing technical purchasing capacity in the
NHF accountability - including mechanisms
transparency and consumer involvement.
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NHF
The Fund will be managed to ensure that money is
spent on high-quality, value-for-money services,
and not wasted on unnecessary treatment.
Individuals will contribute to the Fund when they
are economically active, but the Fund will pay
for care for everyone as it is needed, including
children and the retired
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NHF

• It will be financed by a combination of
• Contributions from employers and employees based
  on income
• An annual GoA contribution from the Consolidated
  Fund (which may result in a new levy or levies on
  the consumption of selected items)
• Any other sources as may be decided by ExCo from
  time to time.

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HEALTH AUTHORITY OF ANGUILLAHEALTH SYSTEM
ACCREDITATION

• ACHIEVING IMPROVED MEASUREMENT (A.I.M.)
• WITH
• CANADIAN COUNCIL ON HEALTH SERVICES ACCREDITATION

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OBJECTIVES OF ACCREDITATION

• PROVIDES A BASIS FOR ENSURING MINIMUM STANDARD OF
  CARE BENCHMARKED AGAINST INTERNATIONAL STANDARDS
• SERVES AS VECHILE FOR DRIVING CONTINUOUS QUALITY
  IMPROVEMENTS
• SERVES AS A BASIS FOR PROMOTING ORGNAIZATIONAL
  TRANSFORMATION AND CHANGE
• ESTBALISHES A BASIS FOR SUSTAINED SYSTEMS
  DEVELOPMENT

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OBJECTIVES OF ACCREDITATION (CONT)

• TOOL FOR ESTABLISHMENT OF GOOD QUALITY AND
  INCREASED PUBLIC CONFIDENCE IN PUBLIC HEALTH
  SERVICES
• INCREASED ORGANIZATIONAL CREDIBILITY AND
  ACCOUNTABILITY

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Strengthening the capacity of MoH

• The MoH has sourced a consultant to assist with
  the following objectives
• Development of a performance measurement
  framework
• Examination and assistance in improving the
  Anguilla MoH Quality Management program including
  staff training.

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Strengthening the capacity of MoH

• Integrate epidemiology to enhance the use of
  information and the effectiveness of policy
  making, program development, and assessment
  related to population health.
• Evaluate and help improve the Ministrys Health
  Planning functions.

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Other Interventions to Strengthen Health Systems

• Establishment of a Department of Health
  Protection including the appointment of a Chief
  Medical Officer, Surveillance Officer, and
  Epidemiologist
• Updating of Environmental Health Legislation

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Other Interventions to Strengthen Health Systems

• Development of legislation to regulate health
  professionals
• HAA surveillance officer identified and dedicated
  specifically to surveillance activities
• Establishment of Quality Management Unit

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New Approaches to Health Systems Management

• Annual Services Agreement in effect
• Performance Appraisal Process implemented
• Recognition and Reward programme established
• Quarterly reviews in effect
• Operational planning framework implemented
• Full delegation of budget to managers

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New Approaches to Health Systems Management

• Board Committees established Patient care,
  Nursing, Human Resources and Finance
• Management Committees established Quality and
  Audit, Health and Safety, Disaster Management and
  Information Management being implemented
• Instrument of Communication (MoH/HAA) being
  implemented

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Framework of Objectives to evaluate Health Sector
Reform

• Access
• Equity
• Quality
• Effectiveness
• Efficiency
• Sustainability

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Access
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Equity
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EFFECTIVENESS
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Efficiency
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Sustainability
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Client Satisfaction

• 80 of patients view doctors as professional and
  caring
• 78 of patients described the food as very good /
  good on taste, appearance and choice
• 94 of patients viewed the physical environment
  as very good / good compared to 64 in 2004
• 95 of dental patients felt their needs were met
• 85 of dental patients viewed staff as prompt and
  helpful in 2005 compared to 73 in 2004
• Source Health Information Department

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There is a need for change to ensure quality,
efficiency, equity, cost containment, financial
sustainability, and inter-sectoral collaboration.
The outcome of this new dispensation of change
seeks to give the people of Anguilla greater
access to health services and empower individuals
and communities to assume responsibility for
their health. ---Source Anguillas National
Strategic Plan for Health