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SM2015 - BELIZE

SM2015 - BELIZE. SM2015 Initiative Innovative Approaches May 2012. Content Health profile Health System SM2015 Objective Components Methodology. Demographic transition.

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SM2015 - BELIZE

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  1. SM2015 - BELIZE SM2015 Initiative Innovative Approaches May 2012

  2. Content • Health profile • Health System • SM2015 • Objective • Components • Methodology

  3. Demographic transition • A reduction in the fertility rate (3.3 to 2.7) and increase in life expectancy (73 years) have resulted in population aging • More than half of the population is below 25 years – 55.6%

  4. Epidemiological transition • Double burden – increasing non-communicable and degenerative diseases related to lifestyle, behaviors and a longer life-span, combined with the continued occurrence of communicable diseases related to poverty, sanitation, environmental conditions, malnutrition and sexual risk behaviors • NCD’s are among the main causes of morbidity and mortality

  5. 05 Protocols Training 09 Quality improvement MNC 10 Protocols Training 04-05 Surveillance system Source: MOH, Health Statistical abstracts • Maternal and infant mortality are low compared to other countries of the region and appear to be declining

  6. Skilled birth attendance is high (96%) Source: MICS, 2006

  7. Quality improvement of maternal and neonatal care • since 2009 • Process • Planning and resource mobilization • Standards and indicators • Training • Policy • Framework • Monitoring tools • Demonstration phase in 2 hospitals • 70% reduction in neonatal death • 65% reduction in birth asphyxia • Spread to rest of hospitals in 2011 • Adapted from University Research Company LLC., maternal and neonatal care package [Nicaragua Office]

  8. Monthly monitoring Quality of process of care in all hospitals

  9. Refresher training at SRH -Revisited monitoring tool - Post reminders New partographform In-service training and practical sessions Median =90 -Staff sensitization -peer coaching Partograph modified Audit sessions with midwives Strategy sample: random selection and convenience, ‘High season’ Midwife: patient Source: medical records Source: MoH, Belize, May 2011

  10. Under-5 mortality rate Source: MoH, Belize, May 2011

  11. Under nutrition (low height for age) is persistent among certain populations – MICS2006 Poorest/richest– three fold Indigenous / Maya 12-23 months of age Stunting in < 5 year old LSMS 2001 – 17.9 MICS 2006 – 17.6 Stunting Standard I Class 1996 – 13.7 2009 - 12.2

  12. Unmet need for reproductive health services, and teenage pregnancy is a priority concern Contraceptive use prevalence rate MICS2006: 1999 – 56% 2006 – 34% Adolescent birth rate / 1,000 females 15-19 1995 - 99 2010 - 73

  13. Adolescent Health • There were 1,356 live births to mothers in the 15-19 year age group, which represents 18.1% of the total live births. • There was an average of 24 live births to mothers under 15 years. • From 2001-2005, there were 145 (41 males and 104 females) new HIV Infections in adolescents 10-19 years • 6.9% of total new HIV Infections (16 ) occurred in the 10-14 age-group; • Early initiation of sexual activity and the prevalence of STIs are public health concerns in this age group. • Fourteen suicides and self-inflicted injuries were reported in the 10-19 age group during 2001-2005.Belize Health Agenda, 2007-2011

  14. Objective The SM2015 Operation in Belize seeks to: Increase the coverage of quality reproductive, maternal, neonatal and child health care in the poorestgeographic areas and increase the use of information in decision making to reduce neonatal death and increase the use of family planning among adolescents

  15. National Poverty Assessment, 2009 Living Standards Measurements Survey % of poor and indigent households per rural/urban districts Where? • Districts with highest increase in poverty rates [2001/2009] • Corozal • Orange Walk • Cayo

  16. Component 1: Strengthening use of data to improve MCH service quality • Expansion of the Collaborative Improvement Model to reduce maternal and child mortality • Expansion and Utilization of the Belize Health Information System in decision making at the local level • System of facility based-incentives at the MoH Clinics in the Northern and Western Regions for expanding coverage and quality • Cross-country exchange and training to improve quality of care

  17. Component 2: Improving Community Based Care • Monitoring and Evaluation of Community Health Workers (CHW) • Currently rolling out community based nutrition initiatives that include breast-feeding promotion, growth-monitoring, and waiting for results to decide about rolling out sprinkles • Incentives for Community Health Workers who reach targets • Currently receive $50 US, exploring incentives that would improve working conditions such as Basic supplies and equipment for CHW and developing a recognition system • Improved coordination and training of CHW (recognition of high-risk cases)

  18. Component 3: Increasing the Coverage of Reproductive Health Services • Increased access to 5 modern family planning methods • Capacity-building in counseling for Patient/Users • Differentiated services designed and used by adolescents

  19. Interventions Making pregnancy safer : Prenatal, postnatal care, skilled birth attendance, managing complicated pregnancy, childbirth and patients in postnatal period, managing complications Immediate and routine newborn care, Managing Complicated neonates Multiple micronutrient supplementation: females 15-49, children Fortified food: pregnant women and children Growth promotion and development: community, facilities 5/7 hospitals certified as baby Friendly Contraceptive methods: public sector and NGO Supplies procured thru UN Agencies [UNFPA, UNICEF] and IDA Foundation. Prevention mother to child transmission: HIV & syphilis…….

  20. Technical assistance in Maternal and child health including reproductive health services • Quality improvement of services utilizing collaborative model • Updating of protocols, standards and indicators, framework and tools for the monitoring of process of care in all areas under the project • Integrated RH services for adolescents • Management of RH supplies • Data management [Belize Health Information System] • Community based care

  21. Health System Structure Ministry of Health National Health Insurance Started in 2001 and operates in three areas: Toledo, Stann Creek and South Side Belize Utilizes P4P through contracts with PCP in private and public health centers Provides free services to all eligible (poorest) populations Focuses on pre-natal and postnatal care and deliveries, and primary care for chronic illnesses such as diabetes, hypertension, and asthma. • Operates in six districts: Belize, Corozal, Orange Walk , CayoStann Creek and Toledo • Employs Service Level Agreements with District Level • Limited planning function, financing of health supply • Interest in introducing incentives

  22. Health System Network 1 National Referral Hospital 3 Regional Hospitals Stann Creek, Beloman, Orange Walk 3 Community Hospitals Toledo, Corazol, y San Ignacio Poly-Clinic 2 Poly-Clinic 1 (primary care) Mobile Units Health Posts-no permanent staff Community Health Workers

  23. NHI Details (1) • The NHI pays the clinics a monthly member capitation payment • Clinics have an incentive to register as many people as they can • Each month, the NHI pays clinics 70 percent of the member capitation payment upfront. • The remaining 30 percent of the payment depends on how the clinic performs on groups of indicators that lead to scores for efficiency • 70 percent of the withheld amount • quality (20 percent of the withheld amount) • and administrative processes (10 percent of the withheld amount) • If an indicator is not fully achieved, then the proportional weight is deducted from the clinic’s total potential payment for that month Source: Michelle Vanzie, Natasha Hsi, AlixBeith, and Rena Eichler (2010): Using Supply-side Pay for Performance to Strengthen Health Prevention Activities and Improve Efficiency: The Case of Belize. USAID Health Systems 2020, P$P Case Studies.

  24. NHI Details (2) Source: Michelle Vanzie, Natasha Hsi, AlixBeith, and Rena Eichler (2010): Using Supply-side Pay for Performance to Strengthen Health Prevention Activities and Improve Efficiency: The Case of Belize. USAID Health Systems 2020, P$P Case Studies.

  25. NHI Details (3) Source: Michelle Vanzie, Natasha Hsi, AlixBeith, and Rena Eichler (2010): Using Supply-side Pay for Performance to Strengthen Health Prevention Activities and Improve Efficiency: The Case of Belize. USAID Health Systems 2020, P$P Case Studies.

  26. Goals 18 months

  27. Goals 36/54 months

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