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«Medium-Term Policy Framework 2011-2014 Ministry of Planning and the Economy October 2011 Table of Contents PREFACE BY THE MINISTER OF PLANNING AND ...»

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Proactively addressing the challenges of the health system requires a comprehensive approach to reducing the incidence of non-communicable and other infectious diseases, promoting healthy lifestyles, addressing the human resource challenges, improving and creating accessible infrastructure as well as introducing a patient-centred approach to health care. Central to this, is an effective managerial approach that is guided by a strong legislative and policy framework that guarantees efficient and effective use of resources and is responsive to crisis situations.

Strategy: Improve Management of Health Sector and Strengthen the Policy and Legislative Framework Operational excellence within the health sector through the strengthening of support systems that meet accreditation standards is crucial. Ensuring quality health services requires a robust legal and regulatory framework.

Updating the legislative and policy framework that governs the sector to reflect commitments to international conventions and protocols will ensure compliance among all stakeholders. The

Key measures to be taken include:

• Implement Accreditation Standards for the Health Sector

• Review and modernise the legislative framework

• Develop systems for tracking and evaluating health sector policy implementation and impact Strategy: Provide Safe, Quality Health Services that are Patient Centered Health care workers must recognise their integral role in the system to provide care in the best interest of the patients whom they serve and as such demand excellence for themselves and from the environment in which they operate. Placing emphasis on patient care, patient rights

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• Establish a Patient’s Authority to investigate allegations of malpractice and patients’ complaints

• Implement the Charter of Patients’ Rights and Obligations

• Establish an Adverse Events Management System

• Conduct process re-engineering for laboratory, pharmacy and radiology services

• Undertake a Health Technology Assessment

• Formulate a policy for use of health services and facilities by the elderly Strategy: Develop an Integrated Primary, Secondary and Tertiary Health Care System Integrated primary and secondary health care is a prerequisite for a well functioning system.

Improving the operation of community health centres will allow for greater accessibility to the services offered. The provision of primary health services at these centres will result in more effective management of patient flows and reduce the burden on major hospitals.

Developing tertiary health institutions into highly specialised diagnostic and treatment facilities with the highest level of care and efficiency will elevate the status of the public health system.

Forging partnerships with foreign health care service providers and research institutions will provide short and long term solutions to address the current limitations of the health sector by working towards a more integrated, complete health care delivery system. The following

specific measures will be taken:

• Develop a National Health Services Delivery Plan that rationalises primary, secondary and tertiary health care services across the various Regional Health Authorities

• Extend operating hours at community health centres

• Upgrade earmarked community health centres to provide diagnostic facilities, screening programmes and multidisciplinary teams to provide holistic care as a method for reducing reliance on the general hospital Strategy: Inculcate a Lifelong Commitment to Health Promoting healthy lifestyles through educational campaigns that emphasise the importance of healthy behaviours including healthy dietary choices and physical activity will form the backbone of the preventive strategy. Developing and remodelling of recreational spaces to Innovation for Lasting Prosperity 50 Medium-Term Policy Framework 2011 - 2014 encourage families and individuals to pursue healthier activities will contribute to reducing the

incidence of lifestyle diseases. Accordingly, the Government will:

• Develop a policy to promote healthy lifestyles with emphasis on sport, nutrition and exercise in order to address the growing problems related to lifestyle diseases

• Develop a National Health Promotion Plan

• Emphasise early diagnostic screening

• Adopt healthy public policy across all state agencies and sectors

• Create partnerships between public and private sector, that catalyse environmental, social and policy changes that promote health Strategy: Develop an Effective Response to Current and Emerging Health Issues The health care system must become results oriented in order to improve the health status of every individual, family and community in Trinidad and Tobago. More importantly, this must be done by taking into account every stage of the life cycle in order to critically assess the

needs of every tier in the population. The specific actions to be taken are:

• Develop and implement the Trinidad and Tobago Health Science Initiative (TTHSI) for Cardiovascular Services inclusive of a Preventative Cardiology Service, Cardiomyopathy and Heart Failure Unit, Electrophysiology and Arrhythmia Service, Interventional Cardiology and a Non-Invasive Imaging Service

• Develop and implement the TTHSI for the Diabetes Outreach Programme (DOP) encompassing an evaluation of patients’ diabetic control, treatment and complication status and the development of a centre of excellence that will be positioned to care for the most complex of cases. It will also include the identification of a trained core programme staff of nurses and assistants, an improved quantitative understanding of the burden of diabetes in Trinidad and Tobago; its prevalence, treatment, complication status and outcomes as well as the development of a registry of people with diabetes in Trinidad and Tobago

• Implement a national programme for screening and treating at risk populations

• Establish a comprehensive programme for children with disabilities including early assessment and service provision

• Strengthen the Children’s Life Fund and ensure that it is functional and responsive

• Implement the Adult Cardiac Surgery Programme for those requiring financial assistance Innovation for Lasting Prosperity 51 Medium-Term Policy Framework 2011 - 2014 Strategy: Develop a Strengthened Response to Mental Health Issues Crucial to maintaining a long, healthy and productive lifestyle is the mental wellbeing of citizens. Emphasis will be placed on the promotion of mental wellbeing and the prevention of mental health conditions, where possible. In addition, efforts to reduce the stigma and discrimination associated with mental illness will be advanced. Reformation of the delivery model for mental health services through decentralisation will ensure greater accessibility in addition to the provision of adequate individualised care for persons who have or are at risk of

suffering from mental disorders. The actions to be taken include:

• Introduce a new Mental Health Act compatible with international and regional human rights norms and standards

• Integrate needs based programmes and mental health interventions for at risk groups into primary health care and community settings

• Formalise partnerships for the provision of psychological therapies to ensure that public health institutions can adequately support our present and projected needs for these services

• Provide training for medical personnel in the care and treatment of mental health disorders Strategy: Modernise Physical Infrastructure for Public Health Care Facilities The quality of health care delivery depends heavily on our physical infrastructure. Government is committed to ensuring that all health care infrastructure is consistently maintained, upgraded and constructed in areas where they are most needed in accordance with international standards.

Ensuring that health care infrastructure caters to both the current and growing demands through an increased number of beds, improved infrastructure in critical care units and the upgrade of equipment in secondary care institutions will help improve the health status of the population.

Some of the specific actions include:

• Construct new hospitals in Point Fortin, Arima, Sangre Grande and Chaguanas

• Establish the National Public Health Laboratory and the Caribbean Public Health Agency at Caura

• Complete construction of the Scarborough Hospital

• Upgrade the San Fernando and existing Sangre Grande Regional Hospitals and the Arima Health Facility

• Establish a Burns Unit at the San Fernando General Hospital and an Oncology Centre at Mt. Hope Innovation for Lasting Prosperity 52 Medium-Term Policy Framework 2011 - 2014

• Upgrade the Children’s Unit at the Mt. Hope Hospital Strategy: Develop Professional and Quality Human Resources Building the human resource capacity and increasing efficiency is of great importance to meeting the goals of the Health Sector. To this end, Government will decrease the human resource shortfall through international recruitment in the short-term while attracting returning nationals to fill the gaps in the medium-term. Expanding and investing in educational opportunities available to citizens through collaborative efforts with tertiary institutions for the development of health related curricula and through scholarship and other incentive programmes will contribute to a decrease in the local skills gap in the longer term. Providing a cadre of qualified health care professionals in the clinical, managerial and technical fields will ensure that the system functions effectively at all levels. An essential factor in this equation is the improvement of the compensatory package offered to health care professionals in order to

recruit and retain staff. Government will also:

• Improve benefits and training to health care workers

• Develop a 10 year Human Resource Manpower Plan

• Promote medical careers through school outreach programmes

• Establish and strengthen specialised facilities and centres for the delivery of patient care and research, winning international reputation for these niches Strategy: Develop an Information and Communication Technology Driven Health Service Delivery and Management ICTs are targeted to play a critical role in the delivery of better and more efficient health care services through the digitisation of patient records and patient administration systems. As such, Government will move towards a fully integrated health information system that facilitates reliable and timely information in order to ensure the efficient and effective delivery of health

care services to citizens. Additionally, action will be taken to:

• Establish the National Health Information Management System (HIMS)

• Develop the Health Information Systems Strategic Plan

• Improve and develop the ICT infrastructure amongst all health sector stakeholders Strategy: Strengthen Health Emergency Preparedness In order to effectively deal with any health emergency, arising out of a natural disaster or other crisis, the collaboration of key stakeholders is essential. Based on this collaboration,

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Strategy: Improve Health Sector Financing Health sector financing can pose a burden on public expenditure if spending is not strategically used to secure value for money, prioritising the most effective treatments, reducing errors and waste and keeping people healthy for as long as possible. Keeping abreast with international best practice in terms of the provision of effective and efficient health care will optimise spending. Introducing a National Health Insurance System (NHIS) to ensure that all of the resources available are used appropriately and effectively to improve the health and wellbeing of the population and provide better treatment and care, will ensure the efficient use of all

available resources. Government will also:

• Increase the funding to the Health Sector over the medium-term, beyond the six (6) per cent of GDP

• Develop a policy for public/private partnership in public health projects to strengthen areas of specialised medicine and to develop facilities for same

• Develop investment promotion packages to attract new investment in projects

• Introduce a NHIS by 2015 Strategy: Develop Niche Areas of Health Care that can Strengthen Trinidad and Tobago’s International Reputation in Health Care The public health care system has had its reputation tarnished at home but Trinidad and Tobago is capable not only of providing first class health care to its own citizens but to the world. This can be done through international partnerships and joint ventures which support the training and development of local professionals, cater to specialised care for our own citizens and which can also support a growing medical tourism market. Opportunities which seem worthwhile to pursue include oncology, cardiac surgery, respiratory ailments and organ transplants.

Innovation for Lasting Prosperity 54 Medium-Term Policy Framework 2011 - 2014 Figure 3 Key Results Health Care Services And Hospitals

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The global economic system now rewards knowledge, enterprise, creativity and adaptability.

In this environment, small states like Trinidad and Tobago now have the opportunity to build sustainable economies that create broadly shared benefits for their populations.

In the new creative knowledge economy, innovation and production are inextricably linked and the ideas, creativity, imagination and talent of the available human capital have replaced natural resources, raw manpower and industrial activity as the primary catalyst for growth and prosperity. Brain power and the creative power of the human imagination are now the drivers of competitive advantage as innovation and talent have become local as well as global assets.

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