ANGUTECH Health Sector Reforms PDF

HEALTH SECTOR REFORMS DR DANIEL OPUNI  Outline of Presentation The ff issues will be considered: Health Sector Reforms (HSR) The focus of HSR from the perspective of WHO AFRO Key issues being addressed in Ghana’s HSR programme Reasons for the introduction of HRS in Ghana (exter...

HEALTH SECTOR REFORMS DR DANIEL OPUNI  Outline of Presentation The ff issues will be considered: Health Sector Reforms (HSR) The focus of HSR from the perspective of WHO AFRO Key issues being addressed in Ghana’s HSR programme Reasons for the introduction of HRS in Ghana (external and internal factors) Current pillars of Ghana’s HSR  Outline of Presentation Inter-sectoral collaboration and HSR Operational challenges in HSR CONCLUSION What is health sector reform (HSR)? A sustained purposeful change aimed at inproving the efficiency, effectiveness, quality and equity of the health sector (Berman 1985) HSR reform is a process that primarily addresses inefficiencies in health service financing and provision  The focus of Health Sector Reforms (WHO AFRO) Guidance on approaches to expand coverage of Essential Health Services through a package of quality health services to improve access, reduce morbidity and mortality rates especially among women and children  The focus of Health Sector Reforms (WHO AFRO) Advocacy for provision of higher quality of basic health services and increased focus on serving the disadvantaged/deprived /hard- to-reach areas and increased focus on serving disadvantaged areas and the vulnerable groups  The focus of Health Sector Reforms (WHO AFRO) Promotion of full community participation** in health services delivery through their involvement in the planning, operation and control of formal health services delivery  The focus of Health Sector Reforms (WHO AFRO) Promoting the contracting of health services to take advantage of private sector resources in the expanding availability and access to quality health services (N/B: PPP and BOT)  The focus of Health Sector Reforms (WHO AFRO) Community involvement, which aims at: Contributing in developing community health policies and strategies to promote communities' ownership and participation in the health system  The focus of Health Sector Reforms (WHO AFRO) Contributing in building institutional and individual capacities for community participation, organisation and management of the health system Increasing awareness of countries and advocate for mainstreaming community ownership and participation in national policies and health strategic plans  The focus of Health Sector Reforms (WHO AFRO) Strengthening coordination of and collaboration with civil society organizations (CSOs) particularly community-based organizations and NGOs in community health development Key issues being addressed in Ghana’s HSR The previous and current programme of work (POW) of Ghana are in the line with reforming the country’s health service. The ff are some of the key issues that are being addressed in Ghana’s HSR: Cost awareness and cost effectiveness Encouragement of innovations in healthcare provision and financing Concerns for consumers (i.e. patients & clients*)- this led to the development of the Patient’s Charter, Code of Conduct and Disciplinary Procedures, Code of Ethics and other Customer care manuals  Key issues being addressed in Ghana’s HSR Assessing performance by results and outputs (through the signing of performance contracts, competitive appointment procedures, limited engagement etc.) Decentralization in the management and allocation of health resources to allow and encourage the use of local initiative, market principles and public- private sector initiatives or participation Reasons for the introduction of HRS in Ghana (External and internal factors) EXTERNAL FACTORS: Worsening economic recession in the 1970s (through e.g. oil crisis, which led the implementation of - the Structural Adjustment Program e.g. PAMSCAD, - deficit financing, - cutting of social sector budget, - reduction of govt. expenditure etc  External reasons for the HSR in Ghana Cumulative effect of the economic recession led to shrinking public finance and mountind debts (by December 2000, Ghana’s debt burden stood at ¢41.1 trillion out of this amount ¢31.1 trillion cedis or US$5.8 billion was external and ¢9.4 trillion or US$1.7 billion was domestic (Ghana Local Government Information Digest, Vol. 14 No. 1, Jan-June 2001 This led Ghana becoming a highly indebted poor country, hence the HIPIC declaration & the need to seek alternative ways of financing and delivering healthcare N/B: find out current debt burden of Ghana* INTERNAL FACTORS THAT ACCOUNTED FOR THE HSR IN GAHNA Economic decline in terms of export earnings from chief export crops like cocoa* High fertility ratio and population growth over the past decades, which led to pressure on available resources New health challenges like growing toll from priority & emerging diseases- HIV/AIDS, TB, Malaria etc Inequities regarding access to health care (geographically and financially) INTERNAL FACTORS THAT ACCOUNTED FOR THE HSR IN GAHNA Inadequate service quality (which stems from - frequent shortage of essential drugs & non- drug consumables, - inadequate emergency services - poor customer care (staff attitude), Inefficient allocation of health resources and Deterioration of healthcare infrastructure vis-à-vis increase pressure following the introduction of NHIS  Current pillars of Ghana’s HRS programme Increased geographical and financial access to basic services Better quality of care in static & outreach services Improved efficiency in the health sector Strengthening of collaboration or partnership between the public health sector and communities, other sectors and private providers (both allopathic & traditional) Increased overall resources in the health sector (equitably and efficiently) Regenerative care (refer to current 5-Year POW Inter-sectoral collaboration in health sector reforms Rationale for intersectoral collaboration? Besides health service delivery, the health of the nation is assessed by other determinants such as female education, water & sanitation, poverty reduction, proper and adequate housing etc These determinants which constitute the health of the nation call for cross sectoral activities, intersectoral collaboration or partnership to address the country’s health priorities Ghana’s medium term health strategy therefore recognizes the importance of such collaboration to address health challenges.  Key areas of collaboration Poverty alleviation Limited access to water and poor sanitation High population growth Poor nutrition Low female literacy Community participation Improving governance & management of the health service Human resource capacity development Reasons for increasing focus in inter-sectoral collaboration Perceived inefficiencies in the public health sector Influence of international agencies who have embraced the role of the private sector Partnership building as a donor conditionality The relatively large size of the public health scetor as compared to available & existing capacity Rising population growth High cost of health care technology growing demand for quality healthcare /medico-legal cases Reasons for increasing focus in inter-sectoral collaboration The private sector is seen as an alternative way of improving resource management and increasing efficiency in service delivery Operational challenges in HSR Lack of common understanding and advocacy of different models by development partners has been a major hindrance for its translation into appropriate policies and plans Inadequate implementation of the notion of multi-sectoral determination of health at various levels  Operational challenges in HSR Low levels of health funding. What is the current per capita Health Expenditure in Ghana? Health financing architecture in most countries is based on minimal contributions from government, high Out-of-Pocket contributions, and vertically programmed donor projects which are not in favour of the PHC approach Operational challenges in HSR Civil strife, natural disasters and diseases of national priority e.g. HIV, TB etc. continue to affect the ability of countries to develop and sustain high quality comprehensive health policies and plans as most health care resources continue to be directed to large urban based hospitals Operational challenges in HSR Issues of governance in the use of resources have sustained donor unwillingness to fund comprehensive broad-based programmes. Vertical, definable, time-limited programmes that could be changed every few years became the sustainable alternative for donor agencies with resultant management challenges on such countries like Ghana Conclusion Countries embarking on HSR should therefore take cognizance of the afore-mentioned operational challenges and take proactive measures in resolving them. Comments, Contributions, Clarifications>????? THANK YOU!!