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HEALTH SECTOR REFORM WORKSHOP
REX ST. LUCIAN HOTEL, CASTRIES, SAINT LUCIA

PAPER ON COMMONWEALTH HEALTH MINISTERS MEETING
BARBADOS, NOVEMBER 1998

PRIORITIES AND PROGRESS
MAY 4-6, 1999

INTRODUCTION

The Twelfth Commonwealth Health Ministers Meeting (12CHMM), convened in Barbados on 15-19 November 1999, was attended by representatives of 39 Commonwealth countries, 3 British Overseas Territories, relevant international agencies, regional bodies and non-governmental organisations, 32 delegations were led by ministers and 3 by Deputy Ministers.

The theme for the Meeting, Health Sector Reform in the interests of health for all, was chosen by Ministers at the conclusion of their Eleventh Meeting in Cape Town in 1995.  The Agenda, developed through extensive consultation with Senior Officials in the Ministries of Health, comprised a number of key areas identified by countries themselves, and was approved by Ministers at their pre-WHO Meeting in Geneva in May, 1998.  Prior to the Meeting, the Secretariat distributed to delegates relevant documents which had been prepared by member states and expert states and expert writers to facilitate the discussions of the meeting.

SUMMARY OF PRIORITIES AND RECOMMENDATIONS

The priorities and recommendations followed from 3 ½ days of discussions in committees, plenaries and roundtables.  In the closing plenary session, Ministers approved a number of recommendations to be acted upon by governments, Commonwealth regional bodies and other organisations, and the Commonwealth Secretariat.  This paper highlights only some of the key recommendations.  A complete set of recommendations have been widely distributed to countries and are available at this meeting.

Human Resource Development (HRD) in the Health Sector

Ministers expressed serious concerns about the availability of appropriately skilled personnel in the health sector to support the reform process and provide efficient, high quality services.  They identified the need for comprehensive human resource management systems and the need to deal with the migration of skilled personnel, particularly nurses and midwives, who play a pivotal role in the provision of health services.  The impact of decentralisation on health systems and the orientation of ministry officials and health personnel to their new roles also required attention.

Recommendations

Governments:  Ensure that an effective HRD plan is developed for the health sector and monitor its implementation; in developing human resources for health, ensure that:

·         Data collection and information management systems for human resource policy and planning are effective

·         Specific criteria are developed which link staffing to a facility’s function

·         Mechanisms are established to involve nurses and other health professionals in negotiations about health sector reform.

Secretariat:  Examine the factors affecting labour mobility in the health sector; work with countries to create mechanism and incentives that encourage retention or return of trained personnel and identify barriers to the free movement of skilled health workers; Assist countries to strengthen heir human resource Information systems which contribute to the planning of effective workforce deployment and to the identification of disparities in the distribution of staff e.g. between urban and rural settings.

Mainstreaming gender in the Health Sector

Ministers acknowledged the persistence of gender disparities in countries and specifically in many areas of health including: nutrition, access to health services, recruitment, deployment, terms and conditions of service.  They noted the benefits of gender equality to health.

Recommendations

Government: Mainstream the gender issue in the planning and management of health systems; ensure that health sector reforms enhance gender equity, taking into account the differential health issues and needs of both women and men; ensure that gender and age disaggregated data are collected at all levels of the health system, analysed and utilised in planning and programme development and service provision.

Secretariat:  Continue initiation, development and implementation of gender management systems in the health sector; carry out advocacy directed to national governments and other stakeholders to build commitment and encourage the widest possible participation in the GMS process.

Health Information Systems

Ministers agreed that existing health information systems are weak and generally inadequate, while policies and programmes need to be informed by accurate, timely data.

Recommendations

Governments: Focus health information systems on the improvement of quality of life and benefits to the community giving attention to information systems design; the type of information which needs to be collected and how the information systems design; the type of information which needs to be collected and how the information will be used; the design and development of health information systems should be co-originated at the national level;

Senior decision-makers and political leaders should create/encourage a culture of information use; Collect and analyse a minimal set of data for monitoring health services nationally to allow for assessment of disease burdens, health activities, available infrastructure and the use of resources.

Secretariat: Assist countries to acquire properly designed and maintained information systems for the health sector; advise countries on appropriate preparation to prevent disruption and damage to health form the possible impact of the year 2000 ‘millennium bug”.

Sustainable Financing of Health Care Systems.

Ministers recognised the increasing costs of financing public health systems and the need for more sustained methods of financing health care provision, while taking into consideration the impact of various financing options on population groups.

Recommendations

Governments: Carefully examine the options available for financing, including partnerships with the private sector and innovative strategies such as the Singapore model.  No single approach will meet the requirements and circumstances of all countries.  Whichever method or mix of methods is chosen, high priority should be given to issues of equity of access and quality of treatment.  This requires particular attention to the situation of the poor, the vulnerable and disadvantages sections of society, for whom adequate safety nets must be in place.

Health Sector Reforms and Improvement of Health Status and Quality of Life

Government: Set clearly defined goals and targets for health sector reform.  These should cover the full spectrum of health care form health promotion, primary prevention, and early detection to treatment, care, rehabilitation and palliation as well as key infrastructure issues.

Secretariat: Identify appropriate models of good health promotion practice, balancing the various approaches, and disseminate experiences and principles for action across the Commonwealth regions.

Traditional Systems of Health

Ministers agreed that national policies for health should include the recognition of traditional and complementary medicine and their value to health development and health sector reform and recommended the setting up of a working group made up of representatives of the Commonwealth Secretariat, governments and NGOs to develop an action plan to promote and integrate traditional systems of health and complementary medicine within national health systems.

Roundtables: Ageing & Health; cost of Drugs; Obesity; Physical activity; Sport and health

A number of recommendations addressed important issues identified during roundtable discussions including the need to provide appropriate health services for ageing populations; adopt measures to address obesity as a national, rather than individual problem; promoting physical activity and sport as significant contributors to good health and that governments should establish essential drug lists to co-ordinate the distribution, management and rational use of drugs; and the provision of free, essential drugs should involve a regulatory and monitoring framework carried out by trained personnel.

Secretariat: Investigate the potential for countries to set up regional and international collaboration to participate in bulk purchasing, where applicable; address trade issues resulting in inequalities in the cost of drugs in different countries.

Technical Support Group

Ministers agreed to the continuation of the TSG for a further three years.

ASSESSMENT OF PROGRESS MADE SINCE 12CHMM

The Secretariat has:

·         Compiled and distributed the recommendations of 12CHMM to Ministries of Health, regional and international organisations, health professional associations and NGOs

·         Developed the proposal for the Technical Support Group and distributed it to Ministries of Health.

·         Initiated some activities in the 1998/99-work programme.  These include; a regional GMS training workshop in the Eastern Caribbean; identification of issues relevant to recruitment, deployment and retention of health workers; collect and share experiences of successful activities implemented under health sector reform.

·         Initiated collaboration with WHO, health Technologies and pharmaceuticals cluster on a recommendations arising from the drugs roundtable; and facilitated the establishment of the working group on traditional systems of health.

·         Schedules additional activities in the 1999/2000 work programme, including development of a template to assist countries to collect date on the recruitment, employment, retention of health workers; prepare and distribute training materials to support the implementation of gender integration into the health sector; organise training workshops to increase awareness of the role and nature of health promotion and the impact of multisectoral activities on health; collect and share practical experiences in the development of sustainable financing of health care systems.

Importance of 12CHMM to Health Sector Reform

Health Ministers Meetings provide opportunities for Ministers, together with their senior officials, to share country experiences, approve work programmed, review and monitor progress of implementation of activities and recommend continuing action for the Secretariat and member states.  The recommendations of 12CHMM on health sector reform will form the major share of the work programme of the Secretariat’s Health Department for the 3-year period 1999/2001.  In addition, the Commonwealth are more aware of and are willing to share.

Issues for the Secretariat

These include: the limited human and financial resources available to tackle the priority health problems in member countries and the continuing decline in resources in the Secretariat related to the economic decline in Member States.  However the Health Department increases its resources for the health programme through extensive collaboration with other agencies as well as brokering and attracting extra-budgetary funds.  The Department works through a well-distributed network of regional organisations and NGOs which support the health programme. It collaborates with other Divisions in the Secretariat some of which have larger budgetary allocations and are able to provide short-term experts, consultants and training.  Resources are also increased through mobilisation of the key stakeholders form community to international levels, and through encouragement of cross sectoral and concerted strategies that recognise the linkages and synergies between health and other aspects of human resource development.

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