Our Mission

To improve the health status of the people of Trinidad and Tobago by promoting wellness and providing quality health care in an affordable, efficient, equitable and sustainable manner

Milestones

• 1994 NHSP ratified in Cabinet

• 1994 RHA Act establishes the Regional Health Authorities

• 1996 Customer Relations Offices and Officers established at RHAs

• 1996 IDB/GORTT loan agreement for the HSRP signed. Project duration is seven years

• 1997 Project Administration Unit for HSRP established

• 1997 Arima & Mayaro DHFs constructed and operationalised

• 1999 Private Pharmacy Programme launched to make drugs for chronic diseases more affordable

• 1999 Emergency Health Service Pilot Project initiated in Tobago

• 1999 RHA Pension Fund established

• 2000 Emergency Health Service expanded

• 2000 RHA Act amended to reduce number of RHA’s from five to four, NWRHA, ERHA, SWRHA and the TRHA

• 2000 TT$22M in equipment purchased and delivered to replace Y2K non-compliant equipment

• 2000 Couva DHF constructed and operationalised

• 2000 New MOH organizational structure approved by Parliament

• 2000 Members admitted to RHA Pension Plan

• 2000 TT$100M in infrastructure works contracted for hospitals and Primary Care Facilities throughout T&T.  

• 2000 Ministry's Training Plan 2000-2002 approved

• 2001 NHI Pilot Programme to be established

Referral information

Mr. Martin Riley, 
Project Director
Project Administration Unit
868-625-3839
868-625-3777 ext. 248

Office of the Communications Coordinator
Ministry of Health
City Drugs Building
42 Independence Square
Port of Spain
Trinidad, W.I.

Organisation of the HSRP

Click on the map on the right for a visual representation of the organisation of the Health Sector Reform Programme

The Implementation Steering Committee (ISC)

The ISC was established by Cabinet Note in 1995 and amended in 1998. It monitors progress against the agreed benchmarks, assesses the continued viability of the Health Sector Reform Programme, facilitates inter-constitutional co-ordination, and channels policy and organisational issues requiring government decision or international involvement. The ISC is chaired by the Minister of Health and includes the Permanent Secretary, the Chief Medical Officer, and senior officials from the Ministry of Public Administration, the Ministry of Finance, the Ministry of Planning and Development, the Chief Personnel Officer, the Secretary of Health of the THA, the Chairpersons of the Boards of the RHAs, the Director of the PAU, the Senior Health Sector Reform Advisor, and the local representatives of the Inter American Development Bank and the Pan American Health Organisation, and co-opts other experts as needed. The ISC meets monthly.

The MOH Management Executive Team (MET)

The Management Executive Team is chaired by the Minister of Health with the assistance of the Permanent Secretary. The MET includes the Chief Medical Officer, the six managers of the new Directorates under the reorganised MOH, and other senior officers.

The Regional Health Authorities (RHAs)

There are four RHAs, each with responsibility for a region: Tobago, North West, South West and East. They are run by boards which are made up of health professionals and representatives of commerce, industry and the community. The RHAs are autonomous statutory bodies ensuring health care service delivery to all residents in their respective regions. Under the RHA Act, the RHAs own and operate primary and secondary health facilities located in their regions. Tertiary health services are provided by the Eric Williams Medical Services Complex and the General Hospitals in Port-of-Spain, San Fernando, Sangre Grande and Scarborough.
The four RHAs are expected to operate based on Annual Service Agreements (ASAs) with the MOH, and the THA in the case of Tobago. Therefore, the MOH and THA act as purchasers of health services on behalf of the population. Funding to the individual RHAs is based on the cost of running these services.

The Project Execution Team (PET)

The PET is responsible for the execution of programme activities in the Health Sector Reform Programme. The Team comprises representatives from the Ministry of Health Management Executive Team, the Director - Project Administration Unit, Chief Executive Officers of the four Regional Health Authorities and the Director - Health Policy and Planning of the Division of Health and Social Services of the THA.

The PET's functions include:

• Review of implementation progress
• Development of medium and long-term action plans
• Co-ordination of technical support and systems development between the RHAs and the MOH
• Monitoring of the performance of health services and the PAU
• Ensuring a proper flow of information between the MOH/THA, the RHAs and the PAU.

The Ministry of Health (MOH)

The Ministry is vested with the responsibility for all health policy, planning, monitoring, information provision, regulating, financing and purchasing of health services.

The Tobago House of Assembly (THA)

The THA is responsible for all health matters in Tobago. The Division of Health and Social Services under the THA provides input for policy, planning, monitoring, information provision and the regulation of services within the framework of the National Health Policy. The THA gets its financial resources from the Ministry of Finance.

The Project Administration Unit (PAU)

The PAU is responsible for the management of programme execution of the Health Sector Reform Programme. It organises, co-ordinates, manages and administers finances, procurement and disbursement for the physical investment and technical support components of the Programme. It also oversees management development and training activities. The PAU is assisted in the procurement of goods and services by NIPDEC and a Technical Assistance Procurement Firm.

Health sector reform refers to a process of change in institutions and structures in order for them to deal adequately with health development issues.  Health sector reform in Trinidad and Tobago is responsive to a changing epidemiological profile evidenced by the high prevalence of costly, chronic, non-communicable and lifestyle diseases such as cardiovascular illnesses, diabetes and various cancers; problems of service quality; inefficient production and use of services; the need to improve services to indigent and disadvantaged groups, and the failure of the traditional health care model to efficiently pursue and attain health policy objectives.

The mission of the Health Sector Reform Programme (HSRP) of the Government of the Republic of Trinidad and Tobago is "To improve the health status of the people of Trinidad and Tobago by promoting wellness and providing quality health care in an efficient, equitable and sustainable manner."    

Our HSRP is guided by a National Health Service Plan (NHSP), which was developed in conjunction with sector stakeholders, including the general public. The NHSP was ratified by Cabinet in 1994. Among other basic changes to the traditional health care model, it calls for:

            •Strengthening policy development,  planning and implementation capacities within the health sector

            •Separating the provision of services from financing and regulatory responsibilities

            • Shifting public health expenditure and influencing a similar shift in private sector spending to high-priority health problems and cost-effective solutions

            •Establishing new administrative and employment structures which encourage accountability, increased autonomy, and appropriate incentives to improve productivity and efficiency

            • Reducing preventable morbidity and mortality by promoting lifestyle change and other social interventions

The HSRP is financed from Government’s resources (US$58 million) and from an Inter-American Development Bank (IDB) loan of US$134 million.

I. Reorganisation of the Ministry of Health

New Roles and Responsibilities

In March 1999 Cabinet approved the reorganisation plan for the Ministry of Health in line with the strategy outlined in the National Health Service Plan.  The Ministry of Health had historically been the body responsible for ensuring public health and providing the services needed by various groups and sub-groups within the population.  The Ministry had traditionally been required to provide leadership, as well as deliver health care services to the population.  In its new role under the HSRP, the Ministry is the agency vested with the responsibility for health policy, planning, information provision, health promotion, standards setting, and the regulation, monitoring, financing and purchasing of health care services.

The Health Sector Policy Document and the National Health Services Plan both guide the sector and the Ministry of Health as it seeks to achieve the goals articulated and the shared vision for improved health of the population.  In addition, the Government/IDB-funded HSRP, which is being implemented over a seven-year period, that started in June 1996, consists of the following major components:

• Reforming the Ministry of Health in order to make it a policy, planning, regulating, monitoring, financing and information provision body

•Devolution of service delivery and management to the Regional Health Authorities which contract with the Ministry to provide cost-effective services within global budgets, using both public and private providers

•Development of a human resources strategy to achieve the appropriate skill mix and staff levels required to support the new organisational structures, as well as to include the establishment of a Regional Health Authorities Pension Plan Fund for RHA staff

•Rationalisation of health services and infrastructure to focus activities on cost-effective and high-priority interventions, emphasising preventive and promotive services and the strengthening of primary care

•Development of a comprehensive financing strategy for the sector, including the evaluation of user charges and a national health insurance scheme as potential financing mechanisms

•Development of a national Emergency Health Service network to ensure that the entire country has access to a reliable and efficient ambulance service

•Development of a comprehensive network of new and upgraded primary health care facilities and operationalisation of the primary health care approach to promote equity, accessibility, community involvement, self-reliance, sustainability and relevance of service delivery.

II. Decentralisation

To ensure coherence and standardisation among the Regional Health Authorities, the Ministry of Health has adopted a series of policy and administrative measures. In the context of decentralisation, the Ministry has assumed the role of "purchaser" of defined services from the RHAs, annually on behalf of the population. These "purchases" relate to service-related needs as identified through analysis of routinely collected health services information and as revealed in the results of a national survey carried out in 1995. In response to the Ministry’s Purchasing Intentions, the RHAs develop their service and administrative responses. Documents providing estimated costs form the basis for discussion and negotiation with the Ministry, before submission for Government funding.

Once funding has been allocated for the RHAs, Annual Service Agreements (ASAs) are finalised and then signed by the Minister of Health and the Chairman of each RHA Board.  These documents support monitoring and performance evaluation. Apart from ASAs, the Minister also has authority under the RHA Act to give directions to the Boards on matters deemed to be important and necessary.

Human Resource Issues

The Ministry of Health’s Human Resources Strategy aims to support the establishment of the RHAs and to ensure that they are able to effectively manage their human resources. The mix of skills and experience required under the reconfiguration of the health services will be achieved through a combination of recruitment, re-training and upgrading of skills and transfer of staff from the Public Service to the RHAs.  Additionally, adjustments in the size and skills mix of the Ministry’s personnel complement will be achieved through natural attrition, voluntary separation, early retirement and an elaborate training and development programme. In the process, those posts which become vacant in the Public Service will be abolished if not required in the new Ministry structure.

The Human Resources Strategy recognises that there will be a need at some point to invoke provisions such as voluntary separation, early retirement and abolition of certain posts.  In this regard, the Government/IDB Health Sector Reform Programme provides for some compensatory resources for this purpose. 

The RHA Pension Plan Fund

The Government, following years of discussions and deliberations with various stakeholders, including the trade unions, has established a Pension Plan for RHA employees.  The Plan is a contributory one, with benefits superior to those in the Public Service.  Click here to view RHA Pension Fund Plan Members' Booklet.

A Comparison Between the Pensions Act, Chap. 23:52 and the RHA Pension Plan

	PENSIONS ACT, CHAP. 23:52*	RHA PENSION PLAN
Type	Pay-As-You-Go Defined Benefits Plan	Contributory Defined Benefits Plan
Membership	Automatic	Compulsory
Employee Contribution	Nil	5% of salary
Tax Relief	On NIS contributions	On Pension Plan and NIS contributions up to $12,000 per year
Voluntary Contributions	Nil	Additional voluntary contributions can be made to secure additional benefits.
Pension Benefit Formula	2% of Pensionable Emoluments for each year of pensionable service up to maximum of 66 2/3%	2% of Final Salary for each year of pensionable service up to maximum of 66 2/3%
RETIREMENT DUE TO AGE:
Eligibility for: (1) Monthly Pension	(a) Permanent confirmed full time officer age 50 and over with 10 or more years service (b) Temporary officer or an unconfirmed officer with at least 10 years service and not less than 55 years of age. The option to surrender up to 25% to be converted to a lump sum and to receive a reduced monthly pension equal to the remaining 75%.	A permanent full time monthly paid employee of an RHA age 50 and over with at least 5 years plan service.
(2) Lump sum gratuity only	A permanent confirmed full time officer age 50 and over with less than 10 years service.
RETIREMENT DUE TO ILL HEALTH: (1) Monthly Pension	A permanent confirmed full time officer aged 50 and over with less than 10 years service.
DEATH: (1) In service before age 60	Lump sum gratuity payable to Legal Personal Representative.	(a) Lump sum payment to Nominated Beneficiary. (b) Pension to spouse and eligible children.
(2) In service after age 60	Not applicable	(a) Lump sum payment and guaranteed pension for 5 years payable to Nominated Beneficiary. (b) Pension to spouse thereafter.
(3) After retirement	Pension ceases.	(a) Remainder of 5 year guaranteed pension paid to Nominated Beneficiary. (b) Pension to spouse and eligible children thereafter.
RESIGNATION	Permanent confirmed full time officers with 5 or more years service - deferred benefits payable at age 55.	(a) Less than 5 years plan service - refund of contributions with interest. (b) More than 5 years plan service - deferred benefits payable at age 55.

* Permanent Confirmed Civil Servants transferring to the RHA fall under the Pensions act, Chap. 23:52

III. The Primary Health Care Thrust

Primary Health Care is a major aspect of the new health sector programme. The Ministry of Health is of the view that the establishment of an efficient primary health care system is the key to real improvement in the nation’s health services. Under the NHSP the five general hospitals in Trinidad and Tobago, in addition to the St. Ann’s Psychiatric Hospital, are to be supported by a network of some 90 Primary Health Care Facilities, including eight District Health Facilities and four Enhanced Health Centres. Under the HSRP all primary health centres are being upgraded or rebuilt to shift the focus of care away from the hospitals to the health centres. Infrastructure development work and upgrading of all the primary health centres in Trinidad and Tobago will be completed in 2001.

• Click here to view a map of the Public Healthcare Facilities in Trinidad and Tobago

Under the HSRP, four different types of primary health centres are being established. District Health Facilities (DHFs) will serve populations of 150,000 and under. DHFs will be located in St. James, Chaguanas, Mayaro, Siparia, Arima, Princes Town and Couva. They will offer residents of the area and environs 24-hour accident and emergency service. Minor surgery will be available.

Enhanced Health Centres will offer specialised health services such as audiology, ophthalmology and dentistry and will operate five to six days a week. Health Centres will serve populations of 24,000 and less. They will be will open five to six days a week and provide a full range of basic services and limited specialty services. In the less populated areas, Outreach Centres will provide limited services through visiting health professionals.

IV.   Financing Health Care

Historically, the public health sector has been financed from the nation’s tax revenues.  The current system of financing the health care sector from general taxation is neither sustainable nor equitable. The HSRP looks at alternative models of funding for the sector, prime among which is the introduction of a National Health Insurance Scheme (NHIS). 

The National Health Insurance Scheme

This Scheme will be funded through contributions from employers, employees and with the Government paying on behalf of the indigent. Government has agreed to develop the NHIS, initially on a pilot basis. As is known and appreciated, such a system demands many supporting and corollary policies and activities. One of the most fundamental is the articulation and agreement on a package of basic health care services.  Agreed protocols and standards of care, peer review, systems to capture costs and outcomes in a manner supportive of decision-taking, the provision of a unique identifier to each citizen; and user fees for some services are all elements which are germane to the successful implementation of an NHIS.  

Vertical Services

Following the enactment of the RHA Act to ensure that there was no interruption of services during the reorganization period the Ministry of Health retained operational responsibilities for the national vertical services. The National Vertical Services are:

•  Environmental Health

• Insect Vector Control Division

• Public Health Engineering

• Occupational Health Unit

• Nutrition and Metabolism Division
• Trinidad Public Health Laboratory

• Queen’s Park Counseling Centre and Clinic

• National Blood Transfusion Unit

• Veterinary Public Health Division

• Chemistry, Food & Drugs Division

• Pharmacy/Drug Inspectorate Division

• Transport Services

• Health Education Division

• Dental Health

• Library Services

SPECIAL PROGRAMMES:

• Hansen’s Disease Control Programme
• National TB Control Programme
• National AIDS Programme
• Population Programme
• Expanded Programme on immunization

disaster co-ordination

During the transition period the MOH will manage the Vertical Services to maintain and strengthen regulatory and coordinating responsibilities in the provision of these programmes. The MOH will conduct in-depth analyses to inform the long-term strategy in the delivery of these programmes to ensure their efficiency and cost effectiveness.

Development of the Human Resources Capabilities

In respect to Human Resource Development component of the Health Sector Reform Government proposes to take a number of definite steps. These include:

•  Reforming the MOH by putting new structures in place which transform it into primarily a policy-formulation, planning and regulatory body;

• The development of new human resources strategy to support the new organizational structure within the MOH and the RHAs

• Through systematic training programmes help staff develop new skills needed to support service delivery imperatives; develop new attitudes and to help staff at all levels to become more client supportive and friendly;

• Special training programmes to provide technical training to facilitate the structural changes, service changes and to promote preventive medicine;

• The establishment of more extensive and decision making process and the general management of the population’s health

• Training programmes directed not only at enhancing technical knowledge by at improving the quality and delivery of health care delivery and overall patient care;

• The provision of technical support including feasibility and other studies in the implementation of new programmes.

Transfer options of public servants and MOH service providers

An integral part of the HSRP Human Resource Strategy consists of incentives for staff to transfer their employment to the RHAs. The major incentive provided is in the form of a fully funded contributory pension plan, which will guarantee that MOH employees transferring to the RHAs do not lose any of their accrued pension benefits. The GORTT following years of discussions and deliberations with various stakeholders including the unions established the RHA Pension Plan Fund in 1999. The Plan is a contributory one for RHA employees with benefits superior to those in the public service.

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