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Dominica Health Systems and Private Sector Assessment

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Dominica Health Systems and Private Sector Assessment DOMINICA HEALTH SYSTEMS AND PRIVATE SECTOR ASSESSMENT March 2012 This publication was produced for review by the United States Agency for International Development. It was prepared by Sara Sulzbach, Kylie Ingerson, Michael Rodriguez, Taylor Williamson, Michael Hainsworth, Alan Fairbank, Shirley Augustine, and James White for the Strengthening Health Outcomes through the Private Sector and Health Systems 20/20 projects. Health Systems 20/20 Mission The Health Systems 20/20 cooperative agreement, funded by the U.S. Agency for International Development (USAID) for the period 2006–2012, helps USAID-supported countries address health system barriers to the use of life-saving priority health services. Health Systems 20/20 works to strengthen health systems through integrated approaches to improving financing, governance, and operations, and building sustainable capacity of local institutions. Strengthening Health Outcomes through the Private Sector Mission The Strengthening Health Outcomes through the Private Sector (SHOPS) Project is a five-year cooperative agreement (2009–2014) with a mandate to increase the role of the private sector in the sustainable provision and use of quality family planning, HIV/AIDS, and other health information, products, and services. December 2011 (Revised March 2012) Cooperative Agreement No.: GHS-A-00-06-00010-00 Cooperative Agreement No.: GPO-A-00-09-00007 Submitted to: Kendra Phillips Health and HIV/AIDS Team Lead USAID Eastern Caribbean/Barbados Maggie Farrell Population and Reproductive Health/Service Delivery Improvement Bureau for Global Health United States Agency for International Development Scott Stewart, AOTR Health Systems Division Office of Health, Infectious Disease and Nutrition Bureau for Global Health United States Agency for International Development Recommended Citation: Strengthening Health Outcomes through the Private Sector and Health Systems 20/20. March 2012. Dominica Health Systems and Private Sector Assessment. Bethesda, MD: Health Systems 20/20 and SHOPS projects, Abt Associates Inc. Abt Associates Inc. I 4550 Montgomery Avenue I Suite 800 North Bethesda, Maryland 20814 I P: 301.347.5000 I F: 301.913.9061 www.healthsystems2020.org I www.abtassociates.com DISCLAIMER 1 The author‟s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government. DOMINICA HEALTH SYSTEMS AND PRIVATE SECTOR ASSESSMENT 2 3 TABLE OF CONTENTS Acronyms ....................................................................................................................................... 7 Acknowledgments ....................................................................................................................... 10 Foreword ...................................................................................................................................... 12 Executive Summary .................................................................................................................... 14 1. Assessment Methodology ..................................................................................................... 22 1.1 Framework for the Health Systems And Private Sector Assessment Approach ............................... 22 1.2 HSA/PSA Process ............................................................................................................................................... 22 2. Country Background and Health System Profile .......................................................... 24 2.1 Overview of Dominica ..................................................................................................................................... 24 2.2 Demographic Trends ........................................................................................................................................ 25 2.3 HIV/AIDS ............................................................................................................................................................. 26 2.4 Political and Macroeconomic Environment ................................................................................................. 27 2.5 Business Environment and Investment Climate .......................................................................................... 29 2.6 Health System Structure .................................................................................................................................. 30 2.7 Donor Contributions ........................................................................................................................................ 32 3. Governance ...................................................................................................................... 34 3.1 Overview of Governance in Dominica ......................................................................................................... 35 3.2 Policy, Legislation and Regulatory Environment ......................................................................................... 36 3.3 Governance Structures .................................................................................................................................... 39 3.4 Citizen Voice, Responsiveness and Transparency ..................................................................................... 41 3.5 Recommendations ............................................................................................................................................. 43 4. Health Financing .............................................................................................................. 45 4.1 Resource Mobilization and Revenue Collection ......................................................................................... 45 4.2 Risk Pooling and Financial Protection ........................................................................................................... 50 4.3 Resource Allocation .......................................................................................................................................... 51 4.4 Government Budgeting Process ..................................................................................................................... 54 4.5 Recommendations ............................................................................................................................................. 56 5. Service Delivery ................................................................................................................ 59 5.1 Organization of Health Service Delivery ...................................................................................................... 59 5.2 Priority service Areas ....................................................................................................................................... 67 5.3 Service Delivery Access, Coverage, and Utilization .................................................................................. 70 5.4 Efficiency of Service Delivery .......................................................................................................................... 71 5.5 Quality Assurance .............................................................................................................................................. 72 5.6 Recommendations ............................................................................................................................................. 73 6. Human Resources for Health .......................................................................................... 75 6.1 Overview of Human Resources for Health ................................................................................................. 75 6.2 Health Workforce ............................................................................................................................................. 76 6.3 Human Resources Policy and Regulation ..................................................................................................... 78 6.4 Human Resource Management ....................................................................................................................... 79 6.5 Recruitment ......................................................................................................................................................... 79 6.6 Human Resource Development ..................................................................................................................... 80 6.7 Recommendations ............................................................................................................................................. 82 7. Management of Pharmaceuticals and Medical Supplies ............................................... 85 7.1 Overview of Pharmaceuticals and Medical Products System in Dominica .......................................... 85 4 7.2 Policy Framework .............................................................................................................................................. 86 7.3 Regulatory System ............................................................................................................................................. 86 7.4 Medicines and Medical products supply ....................................................................................................... 87 7.5 Rational Use .......................................................................................................................................................
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