Effects of Health SystemsEffects of Health Systems

i. Access barriers to public i. Access barriers to public health serviceshealth services

Group 4Group 4

Englebert Emmanuel (Belize)Englebert Emmanuel (Belize)

Rufus Ewing (Turks & Caicos)Rufus Ewing (Turks & Caicos)

Xysta Edmunds (St. Lucia)Xysta Edmunds (St. Lucia)

Tessa Stroude (Grenada)Tessa Stroude (Grenada)

Sandra Smith (Bahamas)Sandra Smith (Bahamas)

Jackie Gernay (PAHO Jamaica)Jackie Gernay (PAHO Jamaica)

Alfonso Ayala (Belize)Alfonso Ayala (Belize)

Group 4Group 4AccessAccess

Definition: Probability of obtaining health Definition: Probability of obtaining health care when it is neededcare when it is neededHSR doesnHSR doesn’t happen in isolation. ’t happen in isolation. Determinants that affect HSR: global Determinants that affect HSR: global economics, different interpretation, other economics, different interpretation, other initiatives (SRH, older adults, rights of the initiatives (SRH, older adults, rights of the child, vulnerable groups, HIV/AIDS, etc.) child, vulnerable groups, HIV/AIDS, etc.) Barriers: financial (user fee), political, Barriers: financial (user fee), political, geographical, infrastructural, migration, ID geographical, infrastructural, migration, ID requirement for NHI, requirement for NHI,

AccessAccess

There is a need for increase access There is a need for increase access to to populationpopulation considering culture, considering culture, language, economic situation (user language, economic situation (user fees, transport, medications, fees, transport, medications, insurance, NHI, global economy, insurance, NHI, global economy, etc.), identification,etc.), identification,

With HSR access has improved in With HSR access has improved in general. Limitations still exist. general. Limitations still exist.

AccessAccessRationalization process influenced drug Rationalization process influenced drug provision and distribution, levels of care, provision and distribution, levels of care, extension of hours, public information, etc.extension of hours, public information, etc.Table 10: needs desegregation by age Table 10: needs desegregation by age groups, match level of care with age groupsgroups, match level of care with age groupsp 64 rephrasing of questions is neededp 64 rephrasing of questions is neededHas waiting time being reduced at primary Has waiting time being reduced at primary level the same day?level the same day?In the Caribbean, there is a lack of In the Caribbean, there is a lack of comprehensive services with missed comprehensive services with missed opportunities.opportunities.

AccessAccess

Have health facilities reduced their Have health facilities reduced their functional access barriers (language, functional access barriers (language, hours, gender)?hours, gender)?

j. Quality carej. Quality careP. 59P. 59Various levels of initiatives have taken Various levels of initiatives have taken place over time. Not necessarily due to place over time. Not necessarily due to reform. reform. Some initiatives in a fragmented way not Some initiatives in a fragmented way not guided by central level policies guided by central level policies Comments on quality were done yesterdayComments on quality were done yesterdayBarriers: weak central level exercising its Barriers: weak central level exercising its functions functions

Labour market and human Labour market and human resources for healthresources for health

P. 51P. 51

Most countries don’t look seriously at HRMost countries don’t look seriously at HR

Financial and burocratic limitations to deal Financial and burocratic limitations to deal with HR issueswith HR issues

Regional health reform has impacted HR Regional health reform has impacted HR

Inappropriate remuneration triggers Inappropriate remuneration triggers migration of health professionalsmigration of health professionals

Human Resorces managementHuman Resorces management

Rapid turn over of HR for healthRapid turn over of HR for healthA positive impact from HSR has been A positive impact from HSR has been the creation of HR unit at different the creation of HR unit at different levels of developmentlevels of developmentThere are no clear HR development There are no clear HR development plan or strategic framework.plan or strategic framework.Training and hiring of specialists Training and hiring of specialists responds more to public demand rather responds more to public demand rather than a national planthan a national plan

Human Resources managementHuman Resources management

There is minimum work on HR There is minimum work on HR management but not serious HR researchmanagement but not serious HR research

P. 52 Change question to: How is HR P. 52 Change question to: How is HR distributed? Take out yes and nodistributed? Take out yes and no

Remove remuneration and take out yes Remove remuneration and take out yes and noand no

p. 53 Is there professional migration? p. 53 Is there professional migration? Which careers? Where?Which careers? Where?

HRHRTable 18Table 18Clear and comparable periods of time, annual Clear and comparable periods of time, annual basisbasisNeed to clear definition of aux. nurseNeed to clear definition of aux. nurse Table 19Table 19Difference of row 3, 4Difference of row 3, 4Ratios need to disaggregate by year due to Ratios need to disaggregate by year due to social determinantssocial determinantsClarification on contracting modalities in the Clarification on contracting modalities in the tabletable

HRHR

Rephrasing Public Health Schools to Rephrasing Public Health Schools to Schools offering Public Health trainingSchools offering Public Health training

Actors interactionActors interaction

p. 73 p. 73

Were changes formulated by Were changes formulated by agreement of involved actors, including agreement of involved actors, including central authority?central authority?

In the Caribbean, we don’t have health In the Caribbean, we don’t have health system segmentation like in LAsystem segmentation like in LA

Q 5 Include international loans and all Q 5 Include international loans and all of the aboveof the above

ActorsActors

P. 75P. 75

q 11 needs clarificationq 11 needs clarification