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Pan American Health Organization/World Health Organization Jamaica
Quality Assurance in JamaicaQuality Assurance in Jamaica
Jackie Gernay and Stanley LaltaPaper presented
at
LACRSS Regional Forum on A New Agenda for Health Sector Reform
Antigua, Guatemala19—22 July, 2004
Progress and PlansProgress and Plans
Pan American Health Organization/World Health Organization Jamaica
Key Features of The Jamaican Health System
• Population………………...………..….2.4 million• GDP per capita………..………..…….US$2400• Pop. below poverty line….………………..20%• Debt Servicing…………………..….…65% of Gov’t revenue
• Health financing……………………….6% of GDP • Health services
– Public dominates in hospital-based services and health centres– private in pharmaceutical and diagnostic services
• Organisation of public services– Head Office with steering/policy functions; 4 Regions and 14
parishes for delivery of services
Pan American Health Organization/World Health Organization Jamaica
Health indicators
• IMR……………………20/1000LB• MMR………………….106-100,000LB• Life expectancy……..72 yrs• Key health problems
– HIV prevalence 2%– Injuries– Chronic Diseases
Pan American Health Organization/World Health Organization Jamaica
EPHF Jamaica 2001
0.85 0.81
0.6
0.8 0.81
0.68
0.89
0.570.48
0.53
0.9
00.10.20.30.40.50.60.70.80.9
1
EPHF1 EPHF2 EPHF3 EPHF4 EPHF5 EPHF6 EPHF7 EPHF8 EPHF9 EPHF10 EPHF11
QA
Pan American Health Organization/World Health Organization Jamaica
EPHF9: QA in personal and population based health services
0.71
0.32
0.16
0.73
00.10.20.30.40.50.60.70.8
Standards User satis Tech assmt sub natsupport
Pan American Health Organization/World Health Organization Jamaica
QA Progress (1)• Policy framework • Legislation and Regulations• Professional Councils• Licensing and Certification of facilities• Standards, Protocols, Procedures and
Manuals• Audits• Performance Indicators in Service Level
Agreements between MOH and Regions
Pan American Health Organization/World Health Organization Jamaica
QA Progress (2)Specific recent Achievements with +impact:
* Criterion-based audit for maternal mortality
* Chronic diseases management audit
* Evaluation of STI management
* Preparation of NHA
* E.P.I. evaluation
* Decentralisation of complaint mechanism
Pan American Health Organization/World Health Organization Jamaica
QA at sub national level• Southern region• TOR of CE committees in
place ; some committees already active.
• CE work plan done– Quality indicators not yet
in SLA– 1 clinical audit
(hypertension) in progress
– Clinical risk management in place ( HR antenatal clinic in Mandeville)
• Western region• Regional Quality
assurance workgroup• Chaired by lawyer (ext)+
other community members
• Active infection control and drug and therapeutics committees
• Customer satisfaction surveys
Pan American Health Organization/World Health Organization Jamaica
QA structure at MOHCMO
• Standards & RegulationsQA:
Standards developmentQA at MOH central levelQA at sub national levelInvestigation & enforcement ( client advocacy: citizen charter, complaints and litigations)Drug registration
•Health services–Clinical effectiveness–Clinical ethics
–Tech programmesE.P.ISTIMat mortality Chronic disease management auditsDrug utilization review NHAFood safety (HACCP)
Pan American Health Organization/World Health Organization Jamaica
QA Plans (1)• MOH Strategic Plan (2001-2005) --- within
context of Public Sector Modernization Plan
* MOH Tasks —develop standards, legislation, protocols.. And monitor and regulate the sector
* Tasks of Regions —improve delivery of quality health care through adherence to standards..patient feedback system..clinical audit system
Pan American Health Organization/World Health Organization Jamaica
• Performance matrix MOH:– Standards & guidelines– Audits– # complaints investigated– # discharge summaries completed
Pan American Health Organization/World Health Organization Jamaica
QA Performance matrix RHA
• % of essential drugs available in HC• % deliveries attended by trained prof.• % maternal deaths investigated• Functional client complaint mechanism in
hospital ( % resolved satisfactorily)• Death rates hospital and casualty• % discharge summaries completed
Pan American Health Organization/World Health Organization Jamaica
QA Plans (2)
• MOH 10-Year QA Plan (1999—2009)—prepared as part of Health Reform
* Goals—client-focused; data-driven TQM services* Strategies—coordinated actions; training; standards
and indicators in priority areas; preventive maintenance; customer focus; benchmarking; cost control; commence accreditation; QA teams at all levels
Pan American Health Organization/World Health Organization Jamaica
QA Plans (3)• 10-year Clinical Effectiveness Plan (as part of
QA plan)• Key Components —evidence based practices;
clinical audits; continuing professional dev’t; clinical risk mgt.; critical (adverse) incident analysis; clinical performance; accreditation.
• Structure—central coordinator/lead; CE committees and Professional Advisory Panels.
Pan American Health Organization/World Health Organization Jamaica
Strengths 1
• Awareness of QA• Sub national initiatives• Focus on clinical effectiveness• Effectively Integrated in some
programmes (E.P.I., S.T.I.)• Good national expertise
Pan American Health Organization/World Health Organization Jamaica
Strengths 2
• Internal collaboration among departments ex Youth.now
• External Collaboration:– Early Childhood Development ( MOE)– Infirmaries ( Local government)– Nursing homes & maternity centers ( private
sector)– Donor partners
Pan American Health Organization/World Health Organization Jamaica
Weaknesses 1• Fragmentation • Still very “regulations oriented”, • Poor documentation (weak HIS)• Lack of policy registry• Gaps in legislation• Incomplete QA policy• No national technical advisory committee for
QA (proposed as part of the CE strategic plan)• Many inactive committees in field ( QA= one
more?)
Pan American Health Organization/World Health Organization Jamaica
Weaknesses 2
• QA activities largely driven by externally funded projects
• Resource constraints ( HR and $) affect continuity
• Local ownership not clearly established• Audit tools not incorporated in manuals• QA focus on technical vs non technical
Pan American Health Organization/World Health Organization Jamaica
QA should be adopted as astrategy (like health promotion)
supporting the various components of health and not as another
programme
Pan American Health Organization/World Health Organization Jamaica
Recommendations for TC• Support establishment of the national QA
committee• Support development of QA policy• Support CE committees at sub national
level (guidelines, training)• Encourage local QA initiatives• Participatory approach to manual
development• Support integrated HIS
Pan American Health Organization/World Health Organization Jamaica
Guiding principle
• ¨Only when policy choices work in tandem with efforts to assure effective implementation can they have desired effects¨
PAHO/QAP : maximizing quality of care through HSR: the role of QA strategies 2004