Effects of Health Systems

1. Effects of Health Systems i. Access barriers to public health services

2. Group 4 • Englebert Emmanuel (Belize) • Rufus Ewing (Turks & Caicos) • Xysta Edmunds (St. Lucia) • Tessa Stroude (Grenada) • Sandra Smith (Bahamas) • Jackie Gernay (PAHO Jamaica) • Alfonso Ayala (Belize)

3. Group 4Access • Definition: Probability of obtaining health care when it is needed • HSR doesn’t happen in isolation. Determinants that affect HSR: global economics, different interpretation, other initiatives (SRH, older adults, rights of the child, vulnerable groups, HIV/AIDS, etc.) • Barriers: financial (user fee), political, geographical, infrastructural, migration, ID requirement for NHI,

4. Access • There is a need for increase access to population considering culture, language, economic situation (user fees, transport, medications, insurance, NHI, global economy, etc.), identification, • With HSR access has improved in general. Limitations still exist.

5. Access • Rationalization process influenced drug provision and distribution, levels of care, extension of hours, public information, etc. • Table 10: needs desegregation by age groups, match level of care with age groups • p 64 rephrasing of questions is needed • Has waiting time being reduced at primary level the same day? • In the Caribbean, there is a lack of comprehensive services with missed opportunities.

6. Access • Have health facilities reduced their functional access barriers (language, hours, gender)?

7. j. Quality care • P. 59 • Various levels of initiatives have taken place over time. Not necessarily due to reform. • Some initiatives in a fragmented way not guided by central level policies • Comments on quality were done yesterday • Barriers: weak central level exercising its functions

8. Labour market and human resources for health • P. 51 • Most countries don’t look seriously at HR • Financial and burocratic limitations to deal with HR issues • Regional health reform has impacted HR • Inappropriate remuneration triggers migration of health professionals

9. Human Resorces management • Rapid turn over of HR for health • A positive impact from HSR has been the creation of HR unit at different levels of development • There are no clear HR development plan or strategic framework. • Training and hiring of specialists responds more to public demand rather than a national plan

10. Human Resources management • There is minimum work on HR management but not serious HR research • P. 52 Change question to: How is HR distributed? Take out yes and no • Remove remuneration and take out yes and no • p. 53 Is there professional migration? Which careers? Where?

11. HR • Table 18 • Clear and comparable periods of time, annual basis • Need to clear definition of aux. nurse • Table 19 • Difference of row 3, 4 • Ratios need to disaggregate by year due to social determinants • Clarification on contracting modalities in the table

12. HR • Rephrasing Public Health Schools to Schools offering Public Health training

13. Actors interaction • p. 73 • Were changes formulated by agreement of involved actors, including central authority? • In the Caribbean, we don’t have health system segmentation like in LA • Q 5 Include international loans and all of the above

14. Actors • P. 75 • q 11 needs clarification