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Plans> NIDS> Background Papers> Health Sector - Section 4 |
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NATIONAL INTEGRATED DEVELOPMENT STRATEGY Health Sector CHAPTER 4 Management The Ministry of Health and Welfare bears responsibility for the planning and development of public and private health care services. Specifically, the Ministry's role in this regard is to formulate and coordinate policies relevant to planning and monitoring of the performance of health care providers. The Permanent Secretary is responsible for the administration of the Ministry and for supporting the Minister's policy role. The overall management of Health Services lies with the Director of Health Services, who is the chief technical advisor on health and health care issues. Currently the Health Services are administered by the Health Department, which has two operational arms: Peebles Hospital and the Community Health Services. These arms are headed by a Hospital General Manager and a Director of Primary Health Care, to whom the day-to-day management of health services is delegated. The Public Health Act provides the statutory means of promoting and preserving the population’s health, and grants the Minister Responsible for Health duties, powers, and functions. This legislation covers areas such as disease prevention, treatment, and control; health education; environmental health; and the appointment of advisory boards and public health officers. There remains a need for significant review and updating of all current legislation. The BVI have not amended health legislation within the last two decades. There have been several redrafts of the BVI Medical Act and Allied Health professionals Act since 1988, but without any finalization and tabling to bring these amended acts into law. The absence of updated medical legislation has significant implications for the standard of practice both in the public and private sector and precludes the setting up of an impartial Medical Council. This is a matter that deserves the highest priority. Planning and Development This area is coordinated through the office of the Director of Health Services. Programs are developed for submission through the budget process in keeping within government policies. There is no Health Plan within the Health Sector. The last attempt to develop a Plan was undertaken in 1983 with support from the Pan American Health Organization. The overall goal of the health sector is the provision of high quality and accessible primary and secondary health care services to improve the quality of life and the standard of living of the people of the B.V.I. To accomplish this goal the Government aims to promote high quality, cost effective services, choice for the public, and as wide a scope of local services as possible within their technical and financial capability. The peculiar geography and population distribution in the territory lends itself well to a system of geographical zoning and equity-based care. Such a system promotes equal access to care from divergent points within the territory and emphasizes levels of care and appropriate referral linkages based on individual need. The model envisaged calls for two hospital units: a multi-care facility on Tortola and a Community Hospital on Virgin Gorda. These hospital facilities would then be linked to Primary Care Polyclinics in each administrative zone. Other clinics would then feed into these via a comprehensive referral system. The referral system will retain its two present components; local and overseas referral, both of which depend on a strong emergency medical response and evacuation capability. This capability would have to be expanded and developed with clear guidelines fore the diverse scenarios that may obtain from time to time. Health Promotion and Disease Prevention will be the central focus in the future health services and an ongoing need for upgrading the knowledge and skills of all levels of staff in this area is envisioned. In particular, the nursing cadre will have to be singled out for special attention because of their ubiquitous role throughout the territory. The Health Education Division of the Department of Health will also play a central role in the development and monitoring of promotional and preventive activities of all units within the department. Strategic Issues
Challenges
Strategic Goals
Health Reform The British Virgin Islands have an overlay of health systems inherited from periods of colonialism, which are increasingly unable to provide affordable, effective and efficient service as well as respond to ongoing demands. For this reason, the territory, in 1993, attempted to carry out a health reform initiative. Health reform has been described as a process aimed at introducing substantive changes into the different agencies of the health sector, their relationships, and the roles they perform, with a view to increasing equity in benefits, efficiency in management, and effectiveness in satisfying the health needs of the population. This process is dynamic, complex, and deliberate; it takes place within a given time frame and is based on conditions that make it necessary and workable. It is ideally a continuous process responding to dynamic demographic, medical, and economic changes. The BVI Government agreed to undertake United Kingdom Government-funded Health Sector Adjustment Project from 1993 to 1996. A wide range of consultancy assignments were undertaken to examine the health sector with regards to health status, epidemiology, policy, finance and planning and human resources. The objectives of the Project were:
The results of the project were as follows:
The Government’s stated policy is to provide both public and private comprehensive health care, with special focus on women, children, the elderly, the mentally ill, and the handicapped. The government is the main provider of acute medical and surgical services to the population. Government health activities and policies place strong emphasis on health promotion. The BVI does not have a formulated health plan. However, the main priorities are:
Free medical and hospital care is extended to pregnant women, children, the police, indigents, firemen, the elderly, diabetics, and the mentally ill. In an effort to strengthen services at the community level, the Community Health Services Department was established in 1990. The social services unit of the health department was established and became operational in July 1991; it is headed by a social worker, whose primary responsibilities include providing social services support for the Department, particularly regarding mental health and AIDS prevention and control programmes. Health Promotion Many of the territory’s health problems relate to the environment and to lifestyle practices, issues that respond especially well to health promotion. The health care system has begun to focus on disease prevention, health promotion and community-based care. The health sector has utilized mainly three health promotion approaches:
Other strategies include education, the use of mass media, policy and legislation development. Intersectoral action has led to improvement in water supply and quality, an improved housing stock, levels of income and actions to encourage balanced eating and exercise. Other issues that still require considerable action include:
If maximum health benefits are to be realized, the structure of Government and Management should be designed in a way that enables health agencies to comment on the health impact of proposed policies. Furthermore, Government sectors concerned with topics such as education, income security, housing, employment, transportation and communication, and all other controllers of resource used to take account of health as an essential factor when formulating policy. The Health Education Unit has expanded from one health educator in 1988 to one Senior Health Education Officer responsible for management, one Health Education Officer, one communications specialist, one audiovisual technician, and two clerical officers. This division is responsible for the education component of health promotion, and for communication and information, it also provides services to other health department divisions and collaborates with the Department of Education and Culture on school health matters and with the Government Information Service in disseminating information to the public. Priority areas have been identified and health promotion programmes were developed for multi-age groups to provide education/information on such issued as heart diseases, AIDS and other sexually transmitted diseases, nutrition, cholera, and environmental health. Multi-media health promotion is targeted to all community groups, but especially to vulnerable groups like adolescents and young adults. Because it lies within the hurricane belt, the British Virgin Islands has a national emergency organization that coordinates activities related to disaster management. Community awareness and information programmes are used to make people aware of the importance of preparedness. There is an operational hospital response plan in the event of a natural disaster, and key personnel have been trained in emergency procedures. There are basic emergency supplies in each district clinic, and district emergency committees have been set in motion.
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