Caribbean Health Planning Context
(Systems Thinking for Health Systems Strengthening)
Rasul Baghirov, Advisor, Health Systems & Services
Office of Caribbean Programme Coordination
Zooming out … a bigger picture
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Caribbean Cooperation for Health (III), CARICOM
Subregional Caribbean Cooperation Strategy, PAHO
Strengthening Health Systems in each building block
– Financing: shrinking fiscal space, unemployment, limited space for
reforms
– Provision of services: escalating health costs, driven by medicines/
technologies
– HRH: continuous out-migration of health workforce (esp. nurses) and
of population (declining fertility)
– Health information systems: mostly informal collaboration between
public and private sectors; attempts to implement easy solutions –
software
– Governance: weak regulation, especially of the private sector; low
compliance with rules when exist; uneven quality
Office of Caribbean Programme Coordination
Zooming in … PAHO/WHO response to
HRH challenges
HRH Road Map:
– Key role of the Working Group – expertise from within the
Caribbean
– Role of PAHO/WHO as a facilitator, convener, broker
– Scrutiny and reality check by the High Level Meeting on the
Road Map – March 2012 and CMOs meeting in April 2012
– No pre-selected framework for the Road Map but bottom-up
approach
– Key role and support of partners
Office of Caribbean Programme Coordination
Caribbean HRH Road Map Context
National
Regional
HRH ROAD MAP
Health Information Service
Financing Systems Delivery
Office of Caribbean Programme Coordination
Guided by the
Sub-regional
Strategic Plan
20
1 1
20
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Supported by
Sub-regional
Framework for
Strengthening
National HIS
Caribbean HIS Roadmap
12
20
Informed by
country specific
HIS strengthening
priorities and plans
Office of Caribbean Programme Coordination
HIS Interventions at
Sub-Regional & Country Levels
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National/Local Systems Thinking about Health
Systems
Office of Caribbean Programme Coordination
Systems thinking in respect to HRH in
the Caribbean
• More or less regulation?
• Bigger or smaller private sector?
• Passive or active purchasing of health services:
how to remunerate health professionals?
• What is the Objective: Equity? Efficiency?
Quality? Who is to be made happier?
• Where to begin? Do money follow ideas, or ideas
follow the money?
Office of Caribbean Programme Coordination
Model of care: 1) population/territory
covered and the health needs and
preferences 2) an extensive network of
health care facilities 3) a multidisciplinary first level of care 4) delivery
of specialized services at the most
appropriate location; 5) mechanisms to
coordinate health care throughout the
health service continuum; 6) care that is
person-, family-, community-centered
Governance and strategy: 7) a unified
system of governance for the entire
network; 8) broad social participation;
and 9) intersectoral action
Organization and management: 10)
integrated management of clinical,
admin and logistical support systems;
11) sufficient, competent and committed
human resources for health 12) an
integrated information system; and 13)
results-based management.
Financial allocation and incentives:
14) adequate funding and financial
incentives
Office of Caribbean Programme Coordination
First Steps: Enhancing Workforce
Capacity
EDUCATION
& TRAINING
GOVERNANCE
Caribbean
Health
Work
Force
Office of Caribbean Programme Coordination
Human Resources for Health
HRH
Governance
Office of Caribbean Programme Coordination