Integration of Systems and

Services

Operational Experience, MSPAS/IGSSEscuintla, Guatemala

BackgroundBackground

• 1989 pilot plan by Social Security Institute (IGSS) to expand coverage based on the Primary Health Care Strategy.

• MSPAS 1996 Expansion of Coverage and improved quality of basic health care services.

Expansion of Coverage Expansion of Coverage

• Strategy to Expand Coverage:

• Proposed as one of the key elements of the Sectoral Reform.

• Contracts with NGOs for the delivery of basic health services, as well as administration of resources still allocated on the basis of national per capita.

Local CharacteristicsLocal Characteristics

• High proportion of the population are direct recipients or beneficiaries of Social Security

• Both institutions have extensive network of services

• Systematic coordination of the Departmental Bureaus since 1996

• Commitment to the Puerto de San José Pact

Response Response

• Proposal to formalize the coordinated work developed in both institutions

• Proposal to develop the institutional strategy by both institutions

• Selection of a local administrative/ financing entity

Process Process

• Beginning of political negotiation process for both institutions (1 year)

• Harmonization of regulations with the technical authorities of both institutions (1 year)

• Develop the local validation process

• Raising awareness of the work teams

Process Process

• Selection and hiring of personnel.

• Development a uniform induction process.

• Development of a systematic horizontal training process.

• Joint care process begins with the signing of the agreement.

Key Elements of the ModelKey Elements of the Model

• Orientation of Financing

• Regulation

• Control

ProgressProgress

• Provision System: – Portfolio of Services

1. Reproductive Health Care2. Pediatric Care3. Management of Prevalent Diseases4. Environmental Management

ProgressProgress

• Management System: – Annual Operating Plan– Resource management in the service

network – Health surveillance and risk management– Development of joint promotion strategies– Monitoring, supervision, and evaluation

ProgressProgress

• Regulation System: - Vaccination- Acute respiratory diseases- Acute diarrheal diseases- Tuberculosis- Epidemiological surveillance- Vectors and the environment

ProgressProgress

• Information system: - Weekly, monthly, and bimonthly reporting.

Lessons learnedLessons learned

• The universal provision at first-level of care in the department improved equity

• Institutional conditions need to be favorable

• Continuing need for negotiation and lobbying, especially in times of political transition

Lessons learnedLessons learned

• The model needs a legal foundation.

• It should not be replicated except under optimal operative, technical, and political conditions.

• The involvement of operative personnel improves the likelihood of the model’s success.

Lessons learnedLessons learned

• A continuous feedback process must be developed

• Positive reinforcement processes

• Information generated locally must be analyzed at the local level

• There are no single solutions

Weaknesses Weaknesses

• Little understanding of the model at the technical and political levels.

• Continued human resource education with a curative, hospital-centered, biological approach.

• Centering the model’s promotion activities exclusively on provider institutions did not facilitate expansion to other sectors.

Weaknesses Weaknesses

• Scarce information on the model’s operation disseminated to the local, institutional, and national levels.

• The strategy for expanding coverage and the basic package of services does not recognize the value of promotion and educational activities.

• Model did not extend to the other levels of care.

Weaknesses Weaknesses

• Social Security Information System only partially developed and solely to evaluate production

Challenges Challenges

• Break with the notion that the first level of care is the same as PHC

• Use the local epidemiological profile to develop and define the service portfolios

• Influence decisionmakers to ensure the sustainability of the model

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