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Health Systems and HIV in Saint Lucia

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Health Systems and HIV in Saint Lucia SAINT LUCIA HEALTH SYSTEMS AND PRIVATE SECTOR ASSESSMENT 2011 January 2012 This publication was produced for review by the United States Agency for International Development. It was prepared by Michael Rodriguez, Barbara O’Hanlon, Abigail Vogus, Rich Feeley, Carol Narcisse, and Jodi Charles for the Health Systems 20/20 Project and Strengthening Health Outcomes through the Private Sector Project. 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 2006-2011, 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. For additional copies of this report, please email [email protected] or visit our website at www.healthsystems2020.org Cooperative Agreement No.: GHS-A-00-06-00010-00 SHOPS 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. Cooperative Agreement No.: GPO-A-00-09-00007 Submitted to: Kendra Phillips Health and HIV Officer Barbados and the Eastern Caribbean 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 Maggie Farrell, AOTR Population and Reproductive Health/Service Delivery Improvement Bureau for Global Health United States Agency for International Development Recommended Citation: Michael Rodriguez, Barbara O’Hanlon, Abigail Vogus, Rich Feeley, Carol Narcisse, and Jodi Charles. January 2012. Saint Lucia Health Systems and Private Sector Assessment 2011. Bethesda, MD: Health Systems 20/20 project, Abt Associates Inc. Abt Associates Inc. I 4550 Montgomery Avenue I Suite 800 North Bethesda, Maryland 20814 I T: 301.347.5000 I F: 301.913.9061 www.healthsystems2020.org I www.abtassociates.com In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University School of Public Health and Tropical Medicine SAINT LUCIA HEALTH SYSTEMS AND PRIVATE SECTOR ASSESSMENT 2011 DISCLAIMER 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 CONTENTS Acronyms ............................................................................................ ix Acknowledgments ............................................................................... xiii Foreword ........................................................................................... xv Executive Summary ........................................................................... xvii 1. Assessment Methodology .............................................................. 1 1.1 Phase 1: Prepare for the Assessment ........................................................ 1 1.2 Phase 2: Conduct the Assessment ............................................................. 1 1.3 Phase 3: Analyze Data and Prepare the Draft Report .......................... 2 1.4 Phase 4: Validate Findings and Plan Next Steps ...................................... 2 2. Health System Profile and Background ....................................... 3 2.1 Overview of Saint Lucia ................................................................................ 3 2.2 Political and Macroeconomic Environment ............................................. 6 2.3 Business Environment and Investment Climate ...................................... 7 2.4 Health System Overview .............................................................................. 8 2.5 Donor Coordination ..................................................................................... 9 3. Governance ................................................................................... 13 3.1 Overview of Governance in Saint Lucia ................................................. 13 3.2 Overview of Ministry of Health Governance ........................................ 14 3.3 Policy Environment ...................................................................................... 19 3.4 Civil Society Participation in the Health Sector .................................... 20 3.5 Information, Reporting, and Lobbying ..................................................... 22 3.6 Key Findings and Recommendations ....................................................... 24 4. Health Financing ........................................................................... 27 4.1 Resource Allocation Process ..................................................................... 27 4.2 Public Health Expenditures ........................................................................ 28 4.3 Private Financing of Health ........................................................................ 29 4.4 Donor Funding .............................................................................................. 29 4.5 Financing of NNH ........................................................................................ 30 4.6 HIV/AIDS Funding ........................................................................................ 31 4.7 Health Insurance ........................................................................................... 32 4.8 Financing Health – Universal Health Care and Other Proposals ..... 35 4.9 Key Findings and Recommendations ....................................................... 36 5. Service Delivery ............................................................................ 39 5.1 Overview ........................................................................................................ 39 5.2 Structure of the Public Service Delivery System .................................. 40 5.3 Priority Service Areas ................................................................................. 46 5.4 Private Health Care Services ..................................................................... 47 5.5 Service Delivery Access, Coverage, and Utilization ............................ 49 5.6 Quality of Care ............................................................................................. 50 5.7 Key Findings and Recommendations ....................................................... 53 6. Human Resources for Health ...................................................... 57 6.1 The HRH Profile of Saint Lucia ................................................................. 57 6.2 Allocation of Healthcare Workers .......................................................... 59 6.3 Human Resource for Health Policies ...................................................... 61 6.4 Human Resource Management ................................................................. 62 6.5 Human Resource Development ............................................................... 63 6.6 Key Findings and Recommendations ....................................................... 65 7. Pharmaceutical Management ...................................................... 69 7.1 Overview of Pharmaceutical Management ............................................. 69 7.2 Policy Framework ........................................................................................ 70 7.3 Regulatory System ........................................................................................ 70 7.4 Medicines and Medical Products Supply ................................................. 72 7.5 Access to Medicines .................................................................................... 75 7.6 Rational Use................................................................................................... 76 7.7 Financing ......................................................................................................... 77 7.8 Key Findings and Recommendations ....................................................... 79 8. Health Information Systems........................................................ 83 8.1 Overview ........................................................................................................ 83 8.2 Structure and Responsibilities ................................................................... 83 8.3 Existing Platforms and Record Keeping .................................................. 84 8.4 Indicators ........................................................................................................ 86 8.5 Reporting Resources ................................................................................... 87 8.6 Data Collection............................................................................................. 88 8.7 Data Analysis ................................................................................................. 89 8.8 Use of Information for Decision Making ................................................ 90 8.9 Key Findings and Recommendations ......................................................
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