Ahawo komi M. GTZ Santé Cameroun

1. Addressing institutional arrangement bottlenecks for improved quality care(Examples from Cameroonian experience) Ahawo komi M. GTZ Santé Cameroun

2. Introduction Overview of quality management actors and instruments Institutional links to social protection Institutional bottlenecks and consequences Optimizing institutional link Plan

3. The success of social protection organization (SPO) depends on : political will to establish schemes, purchasing power of the community, perceived quality of care The Consumer’s trust in SPO is conditioned by his trust in contracting providers. 1.Introduction

4. 2. Overview of quality managment actors Category Actor Role Health system Policy makers elaborate policies, implement reforms and allocate resources organize, follow and initiate a lot of actions that influence behaviour and practices in the system Health Administrators (Provincial and district officers)

5. 2. Overview of quality managment actors Category Actor Role Supply system Healthsystem Supplies drug and other necessary materials Health facility (health personnel ) Health care providers Local government Other sectors Finance, influence

6. 2. Overview of quality managment actors Actor Role Category Users Potential, perception of health problems that may be different from expectation Household and communities Social protection organisms Purchaser Finance, influence

7. Evidence :Quality care is the result of the interaction of a comprehensive system including all those actors. 2. Overview of quality managment actors

8. Quality managementtools:- Accreditation- Guidelines: norms and standards- Systemic quality management(self evaluation, audit, ranking,..) - Monitoring (Bamako Initiative)- Performance oriented contracts etc..- Supervision- Micro insurance Medical advisor 2. Overview of quality managment actors

9. 2. Overview of quality managment actors Conditions to implement quality management :- Good political will and serious commitment at national level- Decentralization of financial and institutional capacity to improve quality- transparency in the management of the health system- Working as an integrated system- Governance and accountability

10. SPO collaborate with health facilities through contracting Most of the time in weakly defined legal and political systems, non-written or incorrectly defined agreements 3. Institutional links to social protection

11. 3. Institutional bottlenecks and consequences 1. Contract Social Protection organizations Health Facilities Improved access to quality care Quality care Finance 3. Contracting Level 2. Contracting process Improved health outcome

12. Problems regarding contract conception lack of specificity, poor provision in case of non performance..(who will implement the sanctions?) Problems with relation to the contracting process insufficient discussion during pre contracting stage (expectations of the personnel, are we following the same goal?) 3. Institutional bottlenecks and consequences

13. Problems with relation to the contracting process non authorised signatories, (no legal body, no decentralization..) poor follow up few interactions or occasions for reviewing and adapting contracts, insufficient or absence of norms and treatment standards to compare with etc.. Poor negotiation capacity (Small SPO) 3. Institutional bottlenecks and consequences

14. Problems with relation to the contracting level Health facility (difficult to scale up) District or other level (difficult to implement at local level) Without administrators, decision makers, suppliers (few possibility of control, sanction application, investment..) 3. Institutionalbottlenecksandconsequences

15. a social protection organization by its self can not sustainably improve quality of care through contracting with a health facility. Evidence

16. Written contract Consider and include other stake holders as witnesses/signatories in contracting negotiations for improved quality care. Contract at operational level could be specifications of framework conventions linking decision makers at higher levels with SPO including private insurers. Optimizing institutional link

17. Optimizing institutional link comprises follow up committees of commitments could be created at national and local level and include parliamentarians or local governments members for accountability and compliance.Social protection organizations should have good size and better institutional capacity to negotiate good conventions.

18. Murakozi Cyane!