Lisa Tarantino, Health Systems 20/20

1. Eastern Caribbean Countries
Health Systems and Private Sector Assessments
2011
Lisa Tarantino
Antigua and Barbuda Assessment Team
Abt Associates, Inc.
April 24, 2012

2. 7 Countries Assessed
1. Antigua and Barbuda
2. Barbados
3. Dominica
4. Grenada
5. St. Kitts and Nevis
6. St. Lucia
7. St. Vincent and the Grenadines
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3. Objectives
 Improve sustainability of systems and HIV/AIDS programming in
view of diminishing donor funding (PEPFAR funded)
 An overview of the entire health sector organized around the six
HSS building blocks
 A description of pressing health issues and priority system
challenges
 A summary of private sector contributions to health
 Actionable recommendations to strengthen health system and
leverage private health sector
 Develop action plans for addressing priority recommendations
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4. Guiding Principles
 Holistic view of the health system – comprised of public, private
(for-profit) and NGO/FBO elements
 Collaborative, high level of engagement with partners and
stakeholders: MOHs, private sector, USAID, PAHO, NGOs, etc.
 Given declining vertical funding for HIV/AIDS, need for integration
into existing health systems and services
 Recommendation criteria:
 Contributes to the sustainability of the health system
 System focused and addresses key performance criteria
 Equity, Access, Quality, Efficiency, Sustainability
 Feasible in short term, essential in long term
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5. KEY FINDINGS: ANTIGUA AND
BARBUDA
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6. Governance and Leadership
Strengths and Opportunities Weaknesses and Threats
PHC level is well managed Government budget constraints
MOH works with professional Inadequate reporting impacts
councils, which are active accountability (CBH, MSJMC, MOH)
Media has a public information MOH needs human resources for
service and a watchdog function planning and developing regulations
Neighboring country laws and Inadequate strategic planning
regulations can be easily adapted Significant gaps in legislation and
International guidelines used for regulation of the health sector
environmental health & sanitation Some infrastructure investment needed
Public sector reform may impact (MOH)
health sector positively
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7. Human Resources for Health
Strengths and Opportunities Weaknesses and Threats
High levels of competence and
Lack of a comprehensive HRH policy
dedication exist Absence planning mechanism in MOH
Adequate number of health workers Ad-hoc transfers of personnel results in
across most cadres & specializations loss of capacity, mismatch of personnel
and needs of institutions, demotivation
Scholarships to support training
Established/Non-Established disparities
Health training services exist, eg nursing impacting morale
school, relevant faculties of UWI to Limited personnel and services in dental
support pre and in-service training psychiatric/mental health, rehabilitation
(MSJMC internship program) Pharmacy school viability
Public Sector Modernization presents Limited supervisory and appraisal
opportunity to address anomalies in staff capacity in primary health care
designations & conditions of employment
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8. Service Delivery
Strengths and Opportunities
Weaknesses and Threats
Strong primary care, particularly for No system for quality assurance of
infectious diseases, maternal and child health services
health Efficiency of service delivery not
Adequate number of facilities, optimal
distributed evenly across the country  Over reliance on MSJMC for
(both public and private), new hospital minor health issues
Most specialized tertiary care available  Centralized HIV/AIDS treatment
in-country  Gaps in patient referral process
Infrastructure and education/literacy of Insufficient health promotion and
the population education

9. Health Information Systems
Strengths and Opportunities Weaknesses and Threats
Adequate physical resources for HIS Fragmentation of the HIS:
in the public sector  Routine data from MSJMC is
Established routine data collection and not collected by MOH (except
reporting process at primary health care for surveillance)
facilities  Private facilities not part of the
Established surveillance system
system
 Separate data collection and
processing systems for different
types of HIV/AIDS data
Efficiency of data management at
central level
Inadequate use of data for planning

10. Pharmaceuticals & Medical Products
Strengths and Opportunities Weaknesses and Threats
Sufficient pharmaceutical human Weak regulatory framework
resources, facilities Insufficient monitoring/regulation of
Good access to quality facilities and pharmaceuticals, especially
pharmaceuticals in the private sector
Collaborative relationship with PPS in Inadequate Pharmaceutical MIS/data
procuring and monitoring for decision making
pharmaceuticals Inadequate pharmaceutical
management coordination
Existence of national and regional
Absence of Standard Operating
training programs
Procedures
Adequate financial resources for
Lack of standard treatment protocols
procurement
Inconsistent pharmacovigilence
practices

11. Health Financing
Strengths and Opportunities Weaknesses and Threats
7% payroll tax (with no ceiling salary) Lack of available data on what existing
committed to health care service commitments really cost or
Public services available without projections on funding growth in future.
significant financial barriers Fragmented financing: No good data on
total public health expenditure.
15-20% of population has private
Growing burden of chronic disease,
insurance (about 15,000 people)
where primary health system is weakest.
Not a huge need for major capital
There is a danger that tertiary care
investment (MSJMC) commitments will erode the primary care
system.
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12. KEY RECOMMENDATIONS
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13. St. Lucia, Antigua and Barbuda, Dominica
1. Prepare population and leadership for the fact that system is
not currently sustainable, and build political will for change
(Antigua and Barbuda)
2. Invest in financial analysis (costing, NHA) and strategic
planning
3. Prioritize updates and passage of key legislation and gazette
regulations to enforce enacted laws
4. Improve efficiency and quality at all levels of care (strengthen
referral system, collect and use data from hospital, private
sector)
5. Pursue opportunities to engage the private sector as a partner 13

14. Next steps – Action!
1. Dissemination and validation workshops resulted in:
 Prioritization of recommendations by public and private sector
stakeholders
 Action steps discussed, negotiated and agreed
2. Commitments by development partners to consider prioritized
recommendations and plans
3. Technical support sought and accessed from USAID (and
others)
4. Technical support initiated in areas of health financing
strengthening (costing) and private sector mapping
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15. Thank you!
Lisa Tarantino
Antigua and Barbuda Assessment Team
Abt Associates, Inc.
April 24, 2012