Anguilla s Health Reform:

1. Anguilla�s Health Reform:� Towards Strengthening Health Systems and Improving Health Care Provision Presented by Dr. Bonnie Richardson-Lake Permanent Secretary Health & Social Development

3. Background

4. Economic Activity

5. Health Indicators 2005 You can see from these indicators that overall health is relatively good. However Anguilla like most countries in the region continue to struggle with the control of Chronic non-communicable disease like diabetes, hypertension and cancersYou can see from these indicators that overall health is relatively good. However Anguilla like most countries in the region continue to struggle with the control of Chronic non-communicable disease like diabetes, hypertension and cancers

6. Top Causes of Death (2004)

7. Health Care System

8. Primary Health Care

9. Primary Health Care

10. Secondary Care

11. Secondary Care

12. Anguilla�s Health Care Reform

13. Anguilla�s Health Reform

14. Anguilla�s Health Reform

15. Advantages of a Decentralized Model Decisions are made at the service delivery or board level Dept heads control their own budgets�programme budgetingDecisions are made at the service delivery or board level Dept heads control their own budgets�programme budgeting

16. Advantages of a Decentralized Model

17. Preparatory Work

18. Preparatory Work Officers were not given a choice in transfer, but were moved up a step in the pay scale. Legislation is written so that public officers who moved to HAA are not worse off than before the transfer. Strat plan provided direction for the development of the operational plans of each of the departments under the HAA Officers were not given a choice in transfer, but were moved up a step in the pay scale. Legislation is written so that public officers who moved to HAA are not worse off than before the transfer. Strat plan provided direction for the development of the operational plans of each of the departments under the HAA

19. Preparatory Work

20. HAA

21. Structure of HAA

22. MoH This represents just the health portion of the Ministry of Social Development.This represents just the health portion of the Ministry of Social Development.

23. Role of the MoH

24. Strengthening the capacity of MoH

25. Strengthening the capacity of MoH

26. Strengthening Health Systems

27. Pre-requisites for the Establishment of the NHF The provision of the Health Services be removed from political interference Establishment of the HAA Quality of health services improved Accreditation of the HAA by the Canadian Council on Health Services Accreditation NHF management must be free from political interference Establishment of the NHF Board and the recruitment of the NHF Director

28. National Health Fund

29. NHF

30. NHF

31. NHF

32. Financing Options Contributions of 5% of monthly income; 2.5% from employers and 2.5% from employees an annual GoA contribution from the Consolidated Fund which will include Monies used to pay for health coverage for Civil Servants Monies allocated to medical treatment overseas Monies currently paid to the Health Authority of Anguilla Any other sources as may be decided by GoA Executive Council from time to time

33. Anguilla NHF Operations The Fund will buy health care services from providers offering services to a standard acceptable to the Fund It will be managed by a technical capacity able to negotiate quality and prices with providers.

34. Anguilla NHF Operations Providers will include the HAA and approved private practitioners. Selected overseas hospitals will provide specialist tertiary care that cannot be provided adequately on-island

35. Payment for Procedures Primary care will be purchased by the Fund for consumers Providers will be contracted (through an annual service agreement) based on the number of consumers registered with them, and not on a fee-per-item-of-service reimbursement basis.

36. Anguilla NHF Operations Access to hospital and specialist care paid for by the Fund will be through referral by approved primary care providers only. Access to sub-specialist care overseas paid for by the Fund will be only through referral by approved secondary care providers � in practice, the HAA.

37. Anguilla NHF Operations Overseas specialist care will be purchased on a fee-for-service basis but under pre-agreed unit rates. Charges, utilisation rates and the validity of treatment will be monitored by the Fund to maintain quality and value-for-money, and to stay within budget.

38. Patient Registration Providers will be accredited to provide services under the NHF subject to the satisfaction of the Director of the NHF that services provided are of a sufficiently high standard

39. Patient Registration Consumers will be required to register at one primary care provider within 3 months of registering with the NHF They may do this at the start of the Fund�s operations or when they visit a provider for the first time.

40. Patient Registration All dependents and family members will register with the same provider and providers will be limited by a maximum list size in order to ensure quality of care The maximum list size will be decided by the Fund but is likely not to exceed 2,000 persons to include NHF-funded and non-NHF patients.

41. Patient Registration Providers are prohibited from excluding patients wishing to register with them until the maximum list size of patients has been reached.

42. Patient Registration Patients may register with another provider under the following conditions: the receiving provider has space on his/her register for the entire family at least 30 days notice changes cannot exceed more than 3 in a calendar year

43. Other Interventions to Strengthen Health Systems

44. Other Interventions to Strengthen Health Systems

45. Expansion of MoH Human Resources Approval of post for Surveillance Officer for the Ministry Establishment of a Health Planner post separate from planning in other social sectors Expansion of the Directorate of Health Services Quality Management Expansion of the National AIDS Programme

46. New Approaches to Health Systems Management

47. New Approaches to Health Systems Management

48. Framework of Objectives to evaluate Health Sector Reform

49. Access

50. Access The reorganization and expansion of primary health care, more patients have access to core basic package of primary medical care The establishment of health districts and the availability of a health team comprised of family physicians and professional nursing staff, these centres now provide a more sustained and reliable package of services from 8.00 a.m. to 4.00 p.m. The result has been a decrease in the number of non-emergency cases in the A&E

51. Equity

52. EFFECTIVENESS

53. Efficiency

54. Sustainability

55. Client Satisfaction