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GROUP 8
Countries within the group
BAHAMASBARBADOSGUYANAHAITIST. KITTSTRINIDAD & TOBAGOJAMAICASURINAMST. VINCENT
CHALLENGES IN PROVIDING SOCIAL PROTECTION
THESE WERE NUMEROUS WITH MANY BEING COMMON TO THE VARIOUS COUNTRIES.
AS SUCH, MOST WILL BE DEALT WITH COLLECTIVELY
THOSE PECULIAR TO SPECIFIC COUNTRIES WILL BE HIGHLIGHTED SEPARATELY
CHALLENGES
Quality of care
STANDARDISATION OF CARE –
ESPECIALLY BETWEEN PUBLIC AND PRIVATE SECTOR
DIFFICULTY PROVIDING HIGH QUALITY OF CARE AT ALL LEVELS DUE TO SHORTAGE OF EQUIPMENT, STAFF OR SPECIALISED SERVICES;
Accessibility :
CARE/FACILITIES:LOGISTICAL /DEMOGRAPHIC DIFFICULTIESTRANSPORTATION ISSUESFRAGMENTATION OF SERVICESONE OR FEW REFERRAL HOSPITALSPOOR SCHEDULING OF CLINICS; LEADS TO PATIENTS BEING TURNED AWAY BECAUSE “THE DAY AND THEIR COMPLAINT DID NOT COORDINATE”.
LEVELS OF CARE
POOR REFERRAL SYSTEMS LEADING TO LENGTHENED ‘WAIT TIME’ FOR CLINICS OR SPECIALIST CAREMANY LEVELS OF CARE THAT MAY CONFUSE OR FRUSTRATE A PATIENT WHO NEEDS OR DESIRES EMERGENCY OR SPECIALIST CARELEVELS NOT ADEQUATELY FUNCTIONING CAUSING OVERCROWDING AT ANY SPECIFIC LEVEL
DATA COLLECTION /COMMUNICATION
FRAGMENTATION OF DATA COLLECTION AND POOR COLLABORATION AMONG VARIOUS RELEVANT AGENCIES COLLECTING INFORMATION
POOR RECORD KEEPING
LACK OF CAPACITY FOR CREATING AUTOMATED SYSTEMS
IMPLEMENTATION
IMPLEMENTATION OF THE STRATEGIES OUTLINED IN THE STRATEGIC / NATIONAL PLANS FOR VARIOUS REASONS ; LACK OF FINANCE , TECHNICAL SKILLS AND ORGANISATIONAL ABILITY
SUSTAINABILITY OF PROGRAMMES
INADEQUATE FUNDING
INABILITY TO MAINTAIN PROJECTS/PROGRAMMES AFTER IMPLEMENTING AGENCY HAS LEFT DUE TO POOR LOCAL ORGANISATION
IMBALANCE OF ALLOCATION OF FUNDS DUE TO INTER AND INTRA-SECTORAL COMPETITION – BUDGET * HAITI
COMPLIANCE
POOR PATIENT COMPLIANCE WITH TREATMENT, FOLLOW- UP VISITS ETC DUE TO ECONOMIC FACTORS, POOR EDUCATION OR LACK OF AWARENESS.
COST OF HEALTH CARE
MOST OF THE COUNTRIES HAD UNIVERSAL COVERAGE / FREE HEALTH CARE. (SUSTAINABILITY DUE TO POSS.ECON.DIFF)HOWEVER, SOME (HAITI, ST. KITTS) HAD FEES OR COSTS THAT PRECLUDED PATIENTS IN THE LOW SOCIO-ECONOMIC BRACKET FROM ACCESSING SERVICES.
ECONOMIC STATUS OF POPULATION
DETERMINES WHETHER PEOPLE VISIT THEIR HEALTH CARE FACILITIES.
HAITI- CHOICES BETWEEN FOOD VS. HEALTH CARE CAN ARISE
ST KITTS – OVERALL WELL BEING; NUTRITIONAL STATUS CAN BE DETERMINED BY FINANCIAL STABILITY
CLIMATE WITHIN THE COUNTRYTHIS IMPACTS ON HEALTH CARE PROVISION, POLICIES AND IMPLEMENTATION OF PROGRAMMES, AS WELL AS PATIENT’S ABILITY TO AFFORD HEALTH CARE. SOCIAL , POLITICAL, ECONOMIC
JAMAICA: CRIME RATE, UNEMPLOYMENT,
SURINAM: POLITICAL INSTABILTY, GOVERNMENTAL CHANGES AND PREFERENCES
EDUCATION & AWARENESS
PATIENT/POPULATION UNAWARE OF SERVICES OFFERED, DISEASE AND PROGRESSION/COMPLICATIONS-
LATE VISITS TO HEALTH FACILITES:
TERMINAL OR LATE STAGE DISEASE
POOR ANTE, PRE ,POST NATAL CARE
PATIENTS UNAWARE OF THEIR RIGHTS
BARRIERS
CULTURAL – HAITI* WOMEN WILL NOT LEAVE THEIR HOMES FOR AT LEAST 40 DAYS AFTER DELIVERY
LANGUAGE – GUYANA; RECRUITING FOREIGN SPECIALISTS, MIGRATION OF NEIGHBORING PEOPLES
MYTHS*
PATIENT PREFERENCE
ST KITTS – ALTHOUGH TRAINED / EXPERIENCED NURSES ARE AVAILABLE, PATIENTS MAY PREFER TO GO TO A DOCTOR/ PRIVATE CARE FACILITY AND MAY DELAY OR NOT GO BECAUSE THEY CANNOT AFFORD SAME
ACCOUNTABILITY
INAPPROPIATE MECHANISMS TO ADDRESS MATERNAL MORTALITY AT THE INSTITUTIONAL AND NATIONAL LEVEL
INADEQUATE LEGAL FRAMEWORK TO ENSURE COMPLIANCE WITH STANDARDS
CHALLENGES:
HUMAN RESOURCES
Shortage of:
Specialists (medical)
Nurses/ midwives/ skilled or experienced nurses
pharmacists
Trained technicians/ technologists
MIGRATION
THIS FACTOR AFFECTED COUNTRIES IN 2 WAYS:
LOSS OF SKILLED/TRAINED PERSONNELINFLUX OF PERSONS FROM OTHER COUNTRIES WHO REQUIRED SPECIAL CARE OR NECESSITATED ADDITIONAL EXPENDITURE FROM BUDGET(DO YOU DENY THEM CARE?
RECRUITMENT OF SKILLED PERSONNEL
DIFFICULTIES DUE TO
MIGRATION
POOR INCENTIVES ESPECIALLY IN PUBLIC SECTOR
FACILITIES:POPULATION RATIO
LIMITED FACILITIES; GENERAL OR SPECIALISED ( ICU, NICU, ULTRASOUND ETC) TO LARGE POPULATIONS OR SECTIONS OF POPULATIONSDECENTRALISATION RESULTING IN CHALLENGES WITH ACCESS – TRINIDAD – 3 NICUs TO 5 REGIONS
INADEQUATE FACILITIES
THIS CAN LEAD TO OVERCROWDING IN INSTITUTIONS; PEAK DELIVERY PERIODS (CROP SEASON)
GENERATION GAP
POOR COMMUNICATION AND ACCEPTANCE BETWEEN “NEW AND OLD” MEDICAL DOCTORS
NEW CULTURAL INFLUENCES WITH STRONG SEXUAL MESSAGES THAT DIRECTLY THWART HEALTH MESSAGES. FOR EXAMPLE, MUSIC/DANCE THAT GLORIFY THE MACHO MALE OR SEXUAL PROCLIVITIES AS AGAINST A MESSAGE OF ABSTINANCE OR RESPONSIBLE SEXUAL BEHAVIOUR
ST. KITTS
ANEMIA IN PREGNANCY
SHORTAGE OF NURSES TRAINED IN IUCD TECHNIQUES
POOR COMPLIANCE OF PATIENTS – CONTRACEPTIVES -DUE TO SIDE EFFECTS
DIFFICULTY REACHING NEW PATIENTS WHO SHOULD BE SCREENED FOR CANCER
PATIENTS FEAR OF INSTRUMENTATION AND PAIN – PAP SMEAR
JAMAICA
OUTDATED TECHNOLOGY AND FACILITIESDEFICIENT MIDDLE MANAGEMENT – SENIOR PERSONNEL AND INEXPERIENCED PERSONNEL – NO SUCCESSION PLANNINGPOOR HEALTH REFORMS – ‘TOP HEAVY MANAGEMENT; COST RECOVERY PROGRAM EMPHASIS WHICH FORCES INCREASED OUT OF POCKET EXPENSES FOR WOMEN
SURINAME
SPECIALISTS NOT UNDERGOING PRACTICAL CMESGRANTS GIVEN PROVIDE ADVANCED FACILITIES EG EQUIPMENT , WHICH REQUIRE INCREASED COST OF MAINTENANCEPREGNANT WOMEN PAYING HIGHER PREMIUM IN INSURANCE SCHEMENO MONITORING AND REGULATION OF POLICY DEVELOPMENT
BARRIERS
BARRIERS
ACCEPTANCE OF REFORMPOLITICAL CHANGE/INSTABILITYPOVERTYECONOMIC INSTABILITYCULTURAL FACTORSLANGUAGE INABILITY TO SOURCE/TRAIN/RECRUIT PERSONNELADMINISTRATION/GOVERNING COMPOSITION –RE:UNDERSTANDING NEEDS AND ISSUES – AFFECTS DECISION MAKING
BARRIERS CONT’D
RESISTANCE TO CHANGE
DONOR AGENCIES DETERMINING WHERE FUNDING SHOULD BE DIRECTED – OVER ALLOCATION IN SOME AREAS EG HIV/AIDS
OPPORTUNITIES
OPPORTUNITIES AVAILABLE
FREE CARE
IMPLEMENTATION OF NATIONAL INSURANCE PROGRAMMES
GOV’T - GOV’T COLLABORATION- CUBA AND MANY CARIBBEAN COUNTRIES
DONOR AGENCIES- FINANCIAL,DATA, TRAINING ETC – PAHO, USAID,
TRAINING, RECRUITMENT PROGRAMMES NATIONALLY &INTERNATIONALLY
EXPERTISE PROVIDED BY AGENCIES THAT FACILITATES PILOT PROJECTS – GUYANA* -GOOD RESULTS-DECREASED MATERNAL MORTALITY IN REGION 6 DUE TO ASSISTANCE FROM PAHO –IMPLEMENTATION OF PILOT PROGRAMME INVOLVING TRAINING AND EDUCATION.
COLLABORATION WITH STAKEHOLDERS IN DEVELOPING HEALTH CARE PROGRAMMES THAT CAN ASSIST IN VARIOUS ASPECTS ; NGOS, FBOS ETC
HEALTH PROMOTION
SUCCESSFUL STRATEGIES
JAMAICA
PATH- POVERTY ALLEVIATION THROUGH HEALTH EDUCATION- PROVIDES SERVICES FOR POOR/ MARGINALISED OR AGED MEMBERS OF THE POPULATIONNATIONAL HEALTH FUND- PATIENTS’ CARE SUBSIDISED BY GOV’T – THEY MUST HAVE 14 OR MORE SPECIFIC HEALTH CONDITIONS
TRINIDAD
PRESCRIPTION FILLING AT ALL PHARMACIES INSPITE OF ORIGIN OF SAME – DECREASED WAIT TIME AND CONGESTION OF PARTICULAR PHARMACIES
VISION AND HEARING SCREENING FOR ALL CHILDRENLIASON UNITS THAT BRIDGE GAPS BETWEEN PRIMARY AND SECONDARY CARE, MANAGE DEFAULTERS ON CHILDREN’S ISSUESEMPOWERMENT PATIENTS’ CHARTER OF RIGHTS AND OBLIGATIONS
SURINAME
SOCIAL SECURITY SCHEME
INSURANCE SCHEME
SYMPATHETIC MINISTER – FOCUSES ON PUBLIC HEALTH CARE
RECOMMENDATIONS
RECOMMENDATIONS
EMBARK ON AGGRESSIVE HEALTH PROMOTION AND EDUCATION PROGRAMMES THAT INCLUDE;
EDUCATION OF PATIENT- RIGHTS, TREATMENT OPTIONS, SERVICES AND FACILITIES AVAILABLE, ALL ASPECTS OF DISEASES; SIGNS, SYMPTOMS, IMPORTANCE OF HEALTH VISITS ETC
BALANCED ALLOCATION OF FUNDS – NATIONALLY/BUDGET AND FROM DONOR AGENCIES. ALLOCATION SHOULD BE BASED ON NEEDS AND SOUND INVESTIGATION
RECOMMENDATIONS
DEVELOP A HUMAN RESOURCE STRATEGY THAT INCLUDES RECRUITMENT AND RETENTION, TRAINING AND RETRAINING OF STAFF, AS WELL AS DEPLOYMENT BASED ON SKILLS REQUIRED.REGULATIONDEVELOP MINIMUM STANDARDS OF CARE FOR MCHP
RECOMMENDATIONS
FINALISE OR DEVELOP NATIONAL STRATEGIC PLANS AND IMPLEMENTATION PLANS TO SECURE NATIONAL AND INTERNATIONAL FUNDINGDEVELOP PROGRAMMES TO REACH CLIENTS IN RURAL AREAS OR STRENGHTEN EXISTING PROGRAMMES
RECOMMENDATIONS
REMIND COUNTRY DECISION MAKERS OF THE COMMITMENTS TO THE MDGs,
RESOLUTIONS 13, 14 WOMEN AND CHILDREN
RESOLUTION 22, SOCIAL PROTECTION IN HEALTH ETC.
COMMUNITY MEETINGS WITH RELEVANT HEALTH PERSONNEL TO ENHANCE COMMUNICATION, UNDERSTAND NEEDS AND IMPROVE THE EFFICACY AND EFFICIENCY OF DELIVERY OF HEALTH SERVICES
INTEGRATION OF HEALTH AND WELLNESS STRAGIES
EFFECTIVE USAGE OF MEDIATRAINING AT ALL DEFICIENT LEVELSFOSTER HEALTH PROMOTIONMANAGED MIGRATION PROGRAMMESENCOURAGE YOUTH AMBASSADORSINCENTIVES FOR PROFESSIONALSTRAINING FOR EXPORT - * GUYANAEFFECTIVE DEPLOYMENT OF SKILLED PERSONNEL – PYRAMID*RAISE THE AGE OF RETIREMENT - *GUYANA
RECOMMENDATIONS
MORE REVIEWS INTO PATIENT DEATHS – ENSURING THAT HEALTH CARE WORKERS/DOCTORS RECOGNISE THAT THEY ARE ACCOUNTABLEREVIEW MORBIDITYMONITORING AND EVALUATION OF CLIICAL INTERVENTION EFFECTIVENESS
NEXT STEPS
STEPS IN RESPONSEADVOCACY AT ALL LEVELS FOR IMPROVEMENTDEVELOPMENT AND IMPLEMENTATION OF STRATEGIES TO REDUCE MORBIDITY AND MORTALITYENFORCING CMEs- IN-SERVICE, PRE-SERVICE TRAINING; INTEGRATION OF TRAININGWORK TO REGAIN CONFIDENCE OF SECONDARY CARE PROFESSIONALS TO CHANGE CURRENT POLARISED ENVIRONMENTFEEDBACK INFORMATION TO CAREGIVERS TO MAXIMISE HEALTH CARE DELIVERYIMPROVE REACH OF INFORMATION/EDUCATION TO VULNERABLE/TARGET POPULATION
THANK YOU