NATIONAL INTEGRATED DEVELOPMENT STRATEGY
Health Sector
(continued)
CHAPTER
7
RECOMMENDATIONS AND
CONCLUSION
Recommendations
- Review and revision of the
legal regulatory framework.
- Establishment of a
mechanism at the Ministry of Health for liaison with other sectors.
- Establishment of a body
with vested professional and community interest in the form of a board to
support the current operational management of the Hospital and Community
Health Services.
- Need for a Health Financing
Policy.
- Need for a National Health
Insurance feasibility study and a possible implementation of such a scheme.
- User fees (Hospital
Amendment Reg. 195) need to be updated to reflect actual economic costs.
Present regulations do not cover charges for Medical Reports and some other
professional services.
- Alternative financing
mechanisms such as selective privatization of government-owned services and
private capitalization of selected services should be investigated and
possibly initiated.
- Establishment of legal and
other mechanisms to effect collections.
- The number of clinic
facilities needs to be rationalized. A system of polyclinic each manned by a
full public health team and coordinated by District Medical Officers for
these zones would be more efficient.
- A geographic zoning system
with prescribed population catchment areas needs to be agreed on and
implemented.
- Health management
information systems need to be improved by introduction of integrated
computer systems. Besides health care quality issues other areas of concern
include billing, purchasing, storage and inventory control, and maintenance.
- Given the thrust towards
increased utilization of sophisticated technologies in hospital service, the
absence of a biomedical engineer/technologist puts the patient and the
institution at risk.
- The provision of a 24-hour
medical presence in Casualty has increased the demand for pharmaceutical,
laboratory and X-ray services. The workload of these units has all increased
and there is a need to increase the staffing levels to provide adequate
coverage.
- The emergency medical
response needs to be improved by creating ambulance services that are
staffed with adequate numbers of drivers, emergency medical technicians and
emergency room staff.
- A biomedical technology
service needs to be developed.
- The Information Systems
Unit should complete assessment of the HBO hospital software and lead on
implementation.
- Institutionalize a planning
and programming process that emphasizes optimal resource allocation and
priority setting.
- Strengthen the role of the
health sector in national policy formulation by strengthening the Ministry
of Health’s capacity in quality improvement and assurance, regulation of
the industry and resource allocation.
- Strengthen management
information systems to monitory resource flow, measurements of outcome
against plans and goals.
- Develop institutional
arrangements to enable the population greater say in health service
delivery.
- Greater involvement of the
private sector in meeting national health objectives.
- Human resource development
to produce the skill mix of personnel needed in the appropriate numbers for
the future health systems.
- There is a need to increase
expenditure on maintenance in relation to the value of the plant and
equipment.
- Improve availability of
trained personnel.
- Improve the design and
management of maintenance programmes
- Improve biomedical
technology capacity in the territory.
Conclusion
The Health
Sector in the BVI has made great strides over the past thirty years. However
these gains must be safeguarded and an ethos of continued improvements
developed.
The future
health services in the BVI will have to be client-focused with a decreased
emphasis on institutional care and a strong commitment to the strengthening of
primary care services supported by a reliable referral network, to world class
secondary and tertiary care services. Both primary and secondary care must be
strengthened to ensure the best acute care for unexpected medical events such as
trauma, cardiac and other medical events or acute decompensation of chronic
disease.
The training
of a first line of basic providers to provide first responders support is
urgent; aiming to train those in the territory with the greatest mobility and
dispersion (police officers, hotel clerks, taxi-drivers, boat captains,
sportsmen etc.). These persons would provide basic life support. The second line
of responders is the emergency medical technicians with advanced life support
capability (resuscitation and transfer to hospital or evacuation to the relevant
facility).
At the
secondary level the need for a modern hospital facility with an expanded scope
of services is evident. This must provide opportunities for public-private
partnerships for professional health care provider practice as well as
accommodations in keeping with the desire of the populace. This must then be
supported by contracting with a centre of excellence to provide tertiary care.
The technology is available for the development of a network of primary,
secondary and tertiary care by way of telemedicine. Such a network will provide
greater opportunity for medical updates and real time consultations to remote
locations. It will also increase the local confidence in the services as both
the competencies and capacities would be enhanced. Furthermore the need for
treatment outside the territory would be minimized resulting in considerable
cost savings to the territory as well as the maintenance of continued family
support to those in need of care.
A first
priority will have to be the enactment of updated legislation, in order that the
various units in the health service will have a framework in which to function.
This is particularly important for the areas of mental health, social work and
environmental health but no area is exempt.
The entire
process will of necessity have to be phased dependent on availability of funds
and will require commitment of considerable capital funding over several years
for upgrading of physical infrastructure and technology. In addition, long-term
recurrent budgeting will be required for staffing, training and maintenance of
equipment and supplies.
The Ministry
of Health must be strengthen to improve the capacity to monitor, analyze and
report on the state of the public health including identification of need. This
would include:
- The development of existing
and new information resources to improve quality of data output for analysis
and monitoring of public health problems.
- The development of
regulations and the capacity to protect the public from malpractice, unsafe
products, procedures or services.
- The development of the
capacity to provide assurance of public safety through standard setting,
licensing of institutions and practitioners, occupational registration,
monitoring and enforcing, national coordination and technical advise.
Outreach
services including daycare for children and the elderly, home health care,
nursing home facilities and services and community and other sectoral
involvement in assessing health care needs and developing and implementing
strategies for health care delivery must become the rule rather than the
exception.
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