[PPT] - 2013 HEALTH SUMMIT PRESENTATION AT BUSINESS MEETING BY KOBINA ATTA PowerPoint Presentation

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2013 HEALTH SUMMIT PRESENTATION AT BUSINESS MEETING BY KOBINA ATTA BAINSON (LEAD FACILITATOR) 2 MAY, 2012

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OUTLINE

Holistic assessment of sector Costing of health services National Health Accounts Evaluation of Free Maternal Care Review of Capitation in Ashanti Region Review of CHPS policy Highlights of Speeches Conclusion

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HOLISTIC ASSESSMENT SECTOR SCORE

He alth Obje c tive Sc or e 2011 Sc or e 2012

HO 1 +1 HO 2 +1 HO 3

+1

HO 4 +1

+1

HO 5

1

+1 Se c tor Sc or e +2 +3

Outcome is POSITI

TIVE with a Sector Score of +3

Interpreted as a highly performing sector

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PROGRESS AND CHALLENGES

1.OPD/capita: 1.17 (double 2006 figure) 2.Supervised delivery:

 national coverage was 58.2%:

 low coverage in Northern and Volta regions

3.EPI coverage: since 2007 coverage has steadily been close to 90%

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0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% AR WR NR BAR CR VR UE R UWR E R GAR T

ta l

2010 2011 2012

HEALTH INSURANCE

 Slight increase in active members to 34%

26%
2%

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HE HEAL ALTH O TH OBJECTIVE 1 1 CONT NT.

g eve ment g ment g ement % non-wage GOG recurrent budget allocated to district level and below 50% 46.8 % 50.0% 55.3% 50.0% 38.5% Per capita expenditure on health 26 US$ 28.6 28.0 35.0 30.0 50.7US D

% population living within 8 km of health infrastructure N/A

N/A
N/A

N/A

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HE HEAL ALTH O TH OBJECTIVES

Indicator 2010 Target 2010 Achiev ement 2011 Target 2011 Achie vemen t 2012 Target 2012 Achie vemen t % of hospitals assessed for quality assurance and control 70%

80.0%

N/A 90.0%

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COST OF HEALTH SERVICES

 Used existing

data, when possible

 Supplemented with

facility-level survey

 Compiled detailed

information about each facility

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AVAILABILITY OF ANTI-MALARIAL DRUGS

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RRH = regional referral hospital HC = health center MAT = maternity clinic PH = public hospital PC = private clinic PHARM = pharmacy

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CAPACITY TO TEST AND TREAT

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RRH = regional referral hospital HC = health center MAT = maternity clinic PH = public hospital PC = private clinic PHARM = pharmacy

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STORING VACCINES

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RRH = regional referral hospital HC = health center MAT = maternity clinic PH = public hospital PC = private clinic PHARM = pharmacy

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NATIONAL HEALTH ACCOUNT

 National Health Accounts (NHA) is an

internationally recognized framework that mea easu sures es and and trac tracks ks total tal he heal alth c care are exp xpend ndit iture ures in a country, thereby providing a systematic and comprehensive method for monit monitoring re

ring resour

urce fl flows ws in a country’s health system.

 Current study compared expenditures in 2005

and 2010,

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TOTAL HEALTH EXPENDITURE BREAKDOWN BY FINANCING SOURCE, 2005 AND 2010

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Allocation of Health Funds from Financing Sources to Functions, 2010

30.83% 2.13% 16.96% 10.80% 88.15% 0.04% 0.18% 6.78% 1.08% 100% 15.20% 3.71% 5.16% 3.92% 11.85% 36.03% 22.31% 32.73% 13.55% 72.22% 0.84% 21.23% 80.61% 5.47% 85.28% 56.31% 76.61% 20 40 60 80 100 120 Ancilliary services to medical care Health administration and health insurance Health and Health- related Expenditure Health-related functions Medical goods dispensed to

utpatients

Prevention and public health services Services of curative care Services of rehabilitative care Percentage of THE Function International Funds Private Funds-Employer Private Funds- HH Public Funds- GoG Public Funds- NHIF

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RECOMMENDATIONS

 Institutionalize the NHA  Build technical capacity locally for resource

tracking

 Need for data disaggregation in the public

sector to inform NHA and provide better analysis of the result

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EVALUATION OF FREE MATERNAL CARE

 Increase in number of facility-based deliveries

by two thirds between 2007 (300,000) and 2011 (500,000); removed financial barrier

 Decreasing trend in the institutional maternal

mortality ratio (GHS data/100,000 live births (230 in 2007 to 170 in 2011)

 Quality of care issues; inadequate human

resources, equipment and infrastructure

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30%

30%

20%

20%

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10% 0% 0% 10 10% 20% 20% 30% 30% 40% 40% 2009 2009 2010 2011 20 2012 12 AR AR WR NR NR BAR BAR CR CR VR VR UER UWR ER ER GAR AR

Percentage c chang anges in in mid midwife po popul pulat ation sinc since 2 2009

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EVALUATION OF FREE MATERNAL SERVICES

 Sustainability: linked to NHIS  Availability of blood products and ambulance

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REVIEW OF CAPITATION PROJECT IN ASHANTI REGION – ANNUAL MEMBERSHIP

0.20 0.23 0.29 0.31 0.33 0.50 0.58 0.79

0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2

2009 2010 2011 2012 Eastern rn

REGISTRED RENEWAL

0.56 0.50 0.49 0.36 0.65 0.83 1.19 0.98

0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2

2009 2010 2011 2012

num number er o

f ac

activ ive m e member ers in in milli lions

Ashant anti

REGISTRED RENEWAL

In 2012, both renewal and registration as shrunk in Ashanti region

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EFFECT AND RECOMMENDATIONS

 Effect: Reduction of outpatient attendance in

health centres and CHPS zones in districts with hospital.

 Recomm

mmend ndati tions

ns: 1.Take gradual approach:

enroll clients into preferred primary provider (PPP) first

 2.Maintain focused and persistent communication  3. Build goodwill across political divide, media and

identifiable interest groups

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REVIEW OF CHPS POLICY

CHPS zones have increased but less functional.

The national context has changed.

What are the implications of the NHIS on

CHPS?

What are implications of decentralization on

CHPS?

How do we retain CHOs and volunteers?
How do we improve managerial accountability?

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RECOMMENDATIONS

 Reorient managers and providers on the

concept

 Strengthen supervision  Improve community participation and

wnership

 Have a broader dialogue to discuss the future

f CHPS in the light of the changing context

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HIGHLIGHTS OF SPEECHES

 To optimize the use of IT we need to identify

strategic use of IT e.g. for health alerts

 To achieve health objectives the Ministry ought

to work with other ministries to establish an inter-ministerial committee

 To reduce incidence of fake medicines we need

to strengthen local manufacture

 Need to consider intangible elements of health

care e.g. customer care and staff attitudes

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HIGHLIGHTS OF SPEECHES

 Need to address the urban menace by

supporting the implementation of the recently developed urban policy

 Explore new financing opportunities in health

through public-private partnerships

31/03/2011 INDEPENDENT REVIEW TEAM 24