BARBADOS
Trends in Health System Change
and Health Sector Reform
Social and Political Context
estimated mid- year population of 273,018
in 2005
sustained GDP growth averaging 3% p.a.
fiscal deficit of 2.5% of GDP
Per capita GDP of US $7,950 ( 2002)
Social and Political Context
cont’d
Tourism remains one of the main foreign
exchange earners and employers of labour
International and Financial Business Services
sector is a growing source of foreign exchange
Construction is buoyant with increasing output
Agriculture contribution to GDP is declining
although non-sugar agriculture and fishing
increased during the period.
Social and Political Context
Cont’d
Unemployment rate fell to single digits from 2001.
Female participation rate in the labour force has
been increasing
Adult literacy rate of 99% in 2004. Approx. 66.7%
of persons enrolled in tertiary institutions are
females
Infant mortality declined from 13.3 per thousand
births in 2002 to 10.1 in 2004, rose to 12.3 in 2005
Maternal Mortality ratio – one and two maternal
deaths in 2002 and 2003 respectively. Nil in 2004
and 2005.
Social and Political Context
Cont’d
Perinatal mortality is a challenge –
fluctuating between 18.6 in 2003 to 15.8 per
thousand births in 2005.
Life expectancy at birth – 72.6 years for
men and 78.3 years for women
1997 Poverty Study found 15% of the
population lived below the poverty line of
BDS $5,503 p.a.
Leading Causes of Death
Disease of pulmonary circulation and other
forms of heart disease
Cerebrovascular diseases
Diabetes mellitus
Ischaemic Heart Disease
Malignant neoplasms of digestive organs
except stomach
HIV/AIDS
Leading Causes of Death
Pneumonia
Hypertension
Malignant neoplasm of prostate
Septicaemia
Acute respiratory infection
Malignant neoplasm of the female breast
Priorities for Change
Management systems – linking planning
and budgeting cycles; - policy formulation
process that is responsive to globalization
Financing Systems - provider – payment
mechanisms; cost and management
accounting systems in institutions
Improving healthcare quality and efficiency
Improving equity of access
Priorities for Change Cont’d
Health Promotion policy
Human resource management
Management information systems
Public Sector Reforms That Impact on
Health Sector Reform
Multi-year budget cycle (three years)
Accrual accounting to replace cash
accounting
Information systems policy
Human resources - performance
management system
Barbados Strategic Plan for
Health 2002-2012
Provides the Health Reform Agenda for the
country
Identifies the Priorities for Action – these
are in keeping with the Caribbean
Cooperation in Health initiative
Has become the blueprint in negotiations
and collaboration with donors and other
stakeholders
Health System Changes
Already Being Implemented
Contractual arrangements with non-state
providers with respect to the following
services:
1. Care of the elderly
2. Provision of treatment for drug
abuse
Autonomy of the Management of the Queen
Elizabeth Hospital
Health System Changes
Being Implemented
Mental Health Reform – the policy
approved by the Cabinet of Barbados places
emphasis on prevention and community-
based treatment.
Health System Change Through
Technical Cooperation
PAHO - BPB
EU – Sector budget support along with
technical assistance
Technical Assistance to the
MOH includes:
Reorganising and strengthening the steering role
of the MOH
Strengthening family health services, specifically
initiating interventions in home and community-
based care for the elderly and the disabled
Reorganising and strengthening health promotion
– policy; management framework which includes
health promotion support unit and implementation
plan.
Technical Assistance to the
MOH includes Cont’d:
Development of information systems to
provide relevant and timely information at
all levels for decision making
- HIS in all institutions
- A central Health Information Unit
- Updated surveillance system
Development of cost accounting systems
Technical Assistance to the
MOH includes Cont’d:
Development of modern cross-cutting
approaches to the management of CNCDs,
starting with cardio vascular disease.
Formulation of policies to strengthen human
resource management:- recruitment and
retention; training; job satisfaction;
appraisal.
The End
Prepared by
Samuel Deane
Planning and Research Unit
Ministry of Health
Barbados