Integration of Systems and Services

1. Integration of Systems andServices Operational Experience, MSPAS/IGSS Escuintla, Guatemala

2. Background • 1989 pilot plan by Social Security Institute (IGSS) to expand coverage based on the Primary Health Care Strategy. • MSPAS 1996 Expansion of Coverage and improved quality of basic health care services.

3. Expansion of Coverage • Strategy to Expand Coverage: • Proposed as one of the key elements of the Sectoral Reform. • Contracts with NGOs for the delivery of basic health services, as well as administration of resources still allocated on the basis of national per capita.

4. Local Characteristics • High proportion of the population are direct recipients or beneficiaries of Social Security • Both institutions have extensive network of services • Systematic coordination of the Departmental Bureaus since 1996 • Commitment to the Puerto de San José Pact

5. Response • Proposal to formalize the coordinated work developed in both institutions • Proposal to develop the institutional strategy by both institutions • Selection of a local administrative/ financing entity

6. Process • Beginning of political negotiation process for both institutions (1 year) • Harmonization of regulations with the technical authorities of both institutions (1 year) • Develop the local validation process • Raising awareness of the work teams

7. Process • Selection and hiring of personnel. • Development a uniform induction process. • Development of a systematic horizontal training process. • Joint care process begins with the signing of the agreement.

8. Key Elements of the Model • Orientation of Financing • Regulation • Control

9. Progress • Provision System: • Portfolio of Services • Reproductive Health Care • Pediatric Care • Management of Prevalent Diseases • Environmental Management

10. Progress • Management System: • Annual Operating Plan • Resource management in the service network • Health surveillance and risk management • Development of joint promotion strategies • Monitoring, supervision, and evaluation

11. Progress • Regulation System: • Vaccination • Acute respiratory diseases • Acute diarrheal diseases • Tuberculosis • Epidemiological surveillance • Vectors and the environment

12. Progress • Information system: • Weekly, monthly, and bimonthly reporting.

13. Lessons learned • The universal provision at first-level of care in the department improved equity • Institutional conditions need to be favorable • Continuing need for negotiation and lobbying, especially in times of political transition

14. Lessons learned • The model needs a legal foundation. • It should not be replicated except under optimal operative, technical, and political conditions. • The involvement of operative personnel improves the likelihood of the model’s success.

15. Lessons learned • A continuous feedback process must be developed • Positive reinforcement processes • Information generated locally must be analyzed at the local level • There are no single solutions

16. Weaknesses • Little understanding of the model at the technical and political levels. • Continued human resource education with a curative, hospital-centered, biological approach. • Centering the model’s promotion activities exclusively on provider institutions did not facilitate expansion to other sectors.

17. Weaknesses • Scarce information on the model’s operation disseminated to the local, institutional, and national levels. • The strategy for expanding coverage and the basic package of services does not recognize the value of promotion and educational activities. • Model did not extend to the other levels of care.

18. Weaknesses • Social Security Information System only partially developed and solely to evaluate production

19. Challenges • Break with the notion that the first level of care is the same as PHC • Use the local epidemiological profile to develop and define the service portfolios • Influence decisionmakers to ensure the sustainability of the model

20. THANK YOU