Ministry of Health and Social Welfare Republic of Liberia OVERVIEW

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Ministry of Health and Social Welfare Republic of Liberia OVERVIEW Powered By Docstoc
					  Ministry of Health and Social Welfare
           Republic of Liberia


OVERVIEW OF THE HEALTH SECTOR


             Dr. Bernice Dahn, BSc, MD, MPH
  Chief Medical Officer / Deputy Minister of Health Services
               MOH&SW Republic of Liberia

                    July 14, 2008
Health Care Overview

•   Maternal mortality is 994/100,000
•   Infant mortality is 72/1,000
•   Under five mortality is 111/1,000
•   Contraceptive rate is 12.9%
•   Access to health care estimated at
    40%. Low access is due to:
     – Brain Drain
     – Damaged/destroyed
       infrastructure
     – Poor road conditions
     – Lack of essential drugs and
       supplies
     – Low salaries and incentives
     – Migration of health workers to
       Monrovia
National Health Policy and Plan Overview
 HEALTH REFORM STRATEGY                                                 POVERTY REDUCTION STRATEGY
                                       NATIONAL HEALTH PLAN 2007 - 2011
                                                            TO PROVIDE FREE
                                                           UNIVERSAL, QUALITY
                                                          AND EQUAL ACCESS TO
                                                           HEALTH CARE TO ALL
                                                                 LIBERIANS




                SUPPORT                                                                                          FINANCIAL
                 MODEL                                                                                           SYSTEMS


          H. NATIONAL POLICY                                                                                NATIONAL BUDGET
           HR MANAGEMENT                                                                                      POOL FUNDING
              HMIS and M&E                        PRIMARY HEALTH       DECENTRALISATION                       NGO's / INGO's
         COMMUNITY PARTICIPATION                         CARE                                            NATIONAL PROGRAMMES
         LOGISTICS + COMMUNICATION                                                                        FAITH ORGANISATIONS
         DRUGS AND MEDICAL SUPPLY                                                                           BILATERAL FUNDS
         STAKEHOLDERS COORDINATION                     COMMUNITY             STRATEGIC                       PRIVATE SECTOR
         PLANNING AND BUDGETING                     EMPOWERMENT          PARTNERSHIPS




                                                                   POST-CONFLICT
                                                                    TRANSITIONAL
                                                                HEALTH CARE DELIVERY
                                                                       MODEL



         1. Emergency Care                                                        * BPHS =          6 basic components
         pre-hospital services, referral systems                                     70% of all healt facilities in the first 2 years
         2. Communicable Dis. Control                                             * Information + awareness = MoH/local authority
         HIV / AIDS, TB, Malaria, Epidemic Outbreaks                                   community awareness of the new strategy
         3. Child Health                                                          * HR Development = training needs & modules
         EPI, IMCI, Nutrition of young children                                           Staffing needs vs Programme needs
         4. RH / Adolescent Care                                                  * Infrastructure + Equipment = standard MoH list
         FP, STDs, Adolescents Reproductive Health                                Develop+publish standard construction models
         5. Maternal / Newborn Care                                               * M&E = Standard national supervisory checklist
         ANC, Safe Deliveries, EmOc, newborn care                                      Indicators - activities - results - constrains
         6. Mental Health                                                         * Financing = MoH salaries, partner incentives
         PTSD, psicosocial, psichiatric, subst abuse                                     partners support to PHC programmes
BPHS INDICATORS :

• Process Indicators
   –   % of facilities with equipment for minimum list in the BPHS.
   –   % of clinics that have infrastructure as indicated in the BPHS
   –   % of clinics with HR as indicated in the BPHS
   –   % of facilities receiving supportive supervision by CHT (3 mos)
   –   % of health facilities with a safe water source (and lights)..
   –   # of County Health Coordination meetings during last 3 mos.


• Coverage/Utilization Indicators
   –   % pregnant women receiving antenatal care from skilled provider.
   –   % pregnant women receiving an ITN during a prenatal care visit.
   –   % births attended by skilled birth attendant (CMW, RN, PA, MD)
   –   DPT3 (Pentavalent) coverage, BCG coverage
   –   Cases of diarrhea, pneumonia, malaria treated according to MOH
   –   TB cure and TB detection rates
POST CONFLICT TRANSITION


 • Health System Transition: the evolution of the health system
   from clinic-focused, emergency-funded services to a county-
   focused system of government and development-funded
   services.




 • Transition Gap: the loss of funding, management and logistics
   and other expertise from emergency focused NGOs and
   partners. If funding levels decline, the likely result is the decline
   of basic services, decreased access to health services, and a
   deterioration of key indicators.
Emergency vs. Development

• Humanitarian Assistance
   – Relief agencies: OFDA, ECHO, PRM, UNICEF
   – Relief NGOs : ACF, IMC, World Vision, IRC, MSF, MDM
   – Basic, clinic-focused, direct emergency services



• Development Assistance
   – Development agencies: USAID, World Bank, DFID, EU
   – Development NGOs (CARE, Save the Children, Academy for Educational
     Development)
   – Capacity building of MoHSW at Central and County Levels
CURRENT SITUATION


• Currently, approximately 52% of Liberia’s health
  facilities are managed by NGOs/ FBOs, 31% by the
  MOHSW, 17% non-functioning

• By the end of 2008, only 36% of the currently
  functioning facilities will be supported, if ongoing
  negotiations do not yield additional funding.

• Community health services, presently fragmented, are
  being reorganized
STAKEHOLDERS : 2006 ASSESSMENT
HUMAN RESOURCES: 2006 ASSESSMENT
ESSENTIAL DRUGS SYSTEMS (2006 ASSESMENT)
OPTIONS FOR DONORS COORDINATION

 Geographic: County-wide
  assistance projects for
  capacity building and
  service delivery, e.g. one
  donor assisting several
  counties via contracts with
  NGOs

   Programmatic: One donor provides TA across at national level
    and across counties for a specific program component, e.g. improve
    the HIS, training CHTs or improving drug supply system.
SUGGESTED LEAD DONOR CONCEPT
                                                  LEAD DONOR RESPONSIBILITIES

                                                              CENTRAL LEVEL

                                                 ENSURE EQUITY ON NATIONAL HEALTH POLICY
                                               COORDINATE ADEQUATE FINANCIAL SUPPORT BPHS
                                                   ENSURE GEOGRAPHICAL ACCESS TO BPHS
                                                PARTICIPATE IN MOHSW / DONOR ROUND TABLES
                                                MEMBER OF THE HEALTH STEERING COMMITTEE
                                                ENSURE STANDARDIZATION OF HEALTH SYSTEMS
                                               REINFORCE FINANCING OF TRAINING INSTITUTIONS




                                                               COUNTY LEVEL

                                           COORDINATE FINANCIAL ISSUES WITH OTHER COUNTY DONORS
                                         RESOLVE IMPLEMENTATION ISSUES WITH IMPLEMENTING PARTNERS
                                                 OVERSEE INGOs AND CHT COORDINATION ISSUES
                                          ENSURE ADEQUATE FINANCIAL SUPPORT TO BPHS COMPONENTS
                                                   PARTICIPATE IN QUARTERLY REVIEW OF BPHS
                                                     SUPPORT ROLL OUT OF BPHS ACTIVITIES




                                                               FACILITY LEVEL

                                                 THROUGH IMPLEMENTING PARTNERS REPORTS ANALYSIS:
         THROUGH IMPLEMENTING PARTNERS




                                                 ENSURE COMPONENTS OF BPHS ARE COVERED
                                               ENSURE REPORTS REFLECT ISSUES AND WAYS FORWARD
                                                   ENSURE HEALTH SYSTEMS ARE FOLLOWED
                                                 OVERSEE ACCESS TO HEALTH TO ALL LIBERIANS
                                               ENSURE ADEQUATE STANDARD PROTOCOLS ARE IN PLACE

                                                PLAN QUARTERLY VISITS TO IMPLEMENTING PARTNERS




                                                             COMMUNITY LEVEL

                                               ENSURE TIME AVAILABLE FOR ANNUAL COMMUNITY VISITS
                                                 OVERSEE COMMUNITIES ARE INFORMED OF BPHS
                                                 DISCUSS C.H. ISSUES WITH IMPLEMENTING PARTNERS
                                                 ALLOW ROOM FOR FINANCING C.H. WITHIN BPHS
Costing of health services within the BPHS
•   Running cost for Health Clinic (up to 1000 patients / month)
    Drugs and medical supplies = 2600 USD including Malaria treatment (ACT) and Parachecks
    Human Resources (incentives) = 661 USD excluding support staff not yet included in the BPHS satff
    Electricity with 5 KVA Generator = 320 USD per month (electricity from 8H00 am to 16H00 pm)
    Stationery (health cards, papers, copies, etc)= 60 USD per month


•   Running Cost for Health Centers (up to 2000 patients / month)
    Drugs and medical supplies = 3,200 USD including ACT and minor surgical procedures supplies, basic EmoC
    Human Resources (incentives) = 1994 USD / month excluding support staff not yet included in the BPHS staff
    Electricity with 5 KVA Generator = 600 USD per month (electricity 18 Hrs a day for inpatients and deliveries)
    Stationary (health cards, papers, copies etc) = 85 USD per month


•   Running Cost for County Hospital (60 Beds, 100 hospitalizations per month and 1200
    IPD consultations per month)
    Drugs and medical supplies = 7, 550 USD including ACT, TB, HIV/AIDS drugs and laboratory as well as Surgical drugs
    / materials mainly for C. Sections
    Human Resources (incentives) = 6,900 USD per month excluding support staff not yet included in the BPHS staff
    Electricity with 15 KVA Generator= 2000 USD per month (electricity 18 hours / day for in patients / deliveries and
    surgery)
    Stationary (health cards, partograms, photocopies, etc) = 200 USD per month

NB = These figures take into consideration ONLY cost to provide direct services.
POOL FUNDING / CONTRACTING OUT

ADVANTAGES
• Empowerment of the MOHSW in service delivery

• Ownership of the health care delivery System

• Sustainability of the Liberian heath systems

• Increase managerial capacity of central MOHSW and CHT

• Ensure GOL / MOHSW priorities in health services

• Avoid duplication of activities

• Ensure the standardization of services
POOL FUNDING / CONTRACTING OUT

                       CHALLENGES

CURRENT SITUATION
•   WEAK TRANSPARENCY IN FUNDING STRATEGIES
•   DIFFICULTY IN COORDINATING GEOGRAPHIC SERVICES
•   COMPLICATED FOR CHT TO SUPERVISE AND MONITOR PROJECTS
•   HIGH RISK OF PARALLEL SERVICES TO CHT ACTIVITIES




POOL FUNDING AND CONTRACTING OUT
•   NEED SPECIFIC CAPACITY BUILDING IN MANAGERIAL STRENGTHS AT
    CENTRAL LEVEL
•   INCLUDE CAPACITY BUILDING OF THE OFFICE OF FINANCIAL
    MANAGEMENT IN MANAGING THE POOL FUNDS
•   NEED TO DEVELOP A STRONG M&E SYSTEM AT CENTRAL AND CHT
CHALLENGES FROM THE GOL PERSPECTIVE

• ALLOCATION FROM THE NATIONAL BUDGET
  RELATIVELY DECREASING IN RELATION WITH THE
  TOTAL NATIONAL BUDGET

• HEALTH NEEDS NOT FULLY REFLECTED IN THE
  NATIONAL HEALTH BUDGET

• MOHSW SALARIES ARE NOT COMPETITIVE WITH THE
  PROFESSIONAL MARKET SALARY
THANK YOU FOR YOUR SUPPORT !