St. Kitts and Nevis Health System Assessment, 2011 - HFG

137 Pages·2012·1.49 MB·English

by  Abigail Vogus

ST. KITTS AND NEVIS
HEALTH SYSTEMS AND
PRIVATE SECTOR ASSESSMENT 2011

April 2012

This publication was produced for review by the United States Agency for International Development. It was
prepared by Laurel Hatt, Abigail Vogus, Barbara O’Hanlon, Kathy Banke, Taylor Williamson, Michael Hainsworth,
and Shirley Augustine 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 2006-2012, 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.
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.
April 2012
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
Cooperative Agreement No.: GPO-A-00-09-00007
Submitted to: Kendra Phillips
Health and HIV Officer
USAID Eastern Caribbean/Barbados

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
Population and Reproductive Health/Service Delivery Improvement
Bureau for Global Health
United States Agency for International Development

Recommended Citation: Hatt, Laurel, Abigail Vogus, Barbara O’Hanlon, Kathy Banke, Taylor Williamson,
Michael Hainsworth, and Shirley Augustine. April 2012. St. Kitts and Nevis Health Systems and Private Sector
Assessment. Bethesda, MD: Health Systems 20/20 project and SHOPS project, Abt Associates Inc.
Abt Associates Inc. I 4550 Montgomery Avenue I Suite 800 North
Bethesda, Maryland 20814 I P: 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

2
ST. KITTS AND NEVIS 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 .........................................................................................
Acknowledgments ......................................................................... 1
Foreword ………………………………………………………………3
Executive Summary ...................................................................... 5
1. Assessment Methodology .................................................... 13
1.1 Framework for the Health Systems and Private Sector Assessment
Approach ...................................................................................................... 13
1.2 HSA/PSA Process ........................................................................................ 13
2. Health System Profile and Background ............................. 15
2.1 Introduction ................................................................................................. 15
2.2 Political and Macroeconomic Environment .......................................... 15
2.3 Key Health Indicators ................................................................................ 17
2.4 Health System Overview .......................................................................... 18
2.5 International Donors ................................................................................. 21
2.6 Public-Private Partnerships ....................................................................... 23
2.7 Health Systems Strengthening Capacity ................................................ 23
3. Governance ........................................................................... 25
3.1 Overview of Governance in St. Kitts and Nevis ................................. 25
3.2 Policy, Legislation and Regulatory Frameworks .................................. 26
3.3 Citizen Voice, Responsiveness, and Transparency ............................. 30
3.4 Governance and Service Delivery .......................................................... 32
3.5 Summary of Key Findings .......................................................................... 33
3.6 Recommendations ...................................................................................... 33
4. Health Financing .................................................................. 35
4.1 Resource Mobilization and Revenue Collection ................................. 35
4.2 Risk Pooling and Financial Protection .................................................... 39
4.3 Resource Allocation and Purchasing ...................................................... 43
4.4 Summary of Key Findings .......................................................................... 46
4.5 Recommendations ...................................................................................... 47
5. Service Delivery ................................................................... 49
5.1 Structure of the Service Delivery System ............................................. 49
5.2 Priority Service Areas ................................................................................ 52
5.3 Access, Coverage, and Utilization of Services ..................................... 53
5.4 Quality Assurance for Health Care ........................................................ 54
5.1 Summary of Key Findings .......................................................................... 55
5.2 Recommendations ...................................................................................... 56
WORKING DRAFT – NOT FOR FORMAL DISSEMINATIO N V
6. Human Resources for Health ............................................. 57
6.1 Health Workforce ...................................................................................... 57
6.2 Human Resource Management and Planning ....................................... 58
6.3 Human Resource Development .............................................................. 59
6.4 Summary of Key Findings .......................................................................... 60
6.5 Recommendations ...................................................................................... 61
7. Management of Pharmaceuticals and Medical Supplies... 63
7.1 Procurement, Distribution, and Storage ............................................... 63
7.2 Pharmaceutical Policies, Laws, and Regulations................................... 66
7.3 Access, Availability, and Affordability ..................................................... 66
7.4 Appropriate Use ......................................................................................... 68
7.5 Quality and Safety ....................................................................................... 68
7.6 Summary of Key Findings .......................................................................... 69
7.7 Recommendations ...................................................................................... 69
8. Health Information Systems ............................................... 71
8.1 Financial, Human, and Physical Resources for HIS ............................. 71
8.2 Data Collection and Information Flows ................................................ 73
8.3 Data Quality, Analysis, and Use .............................................................. 74
8.4 Summary of Key Findings .......................................................................... 75
8.5 Recommendations ...................................................................................... 76
9. Private Sector Contributions to Health ............................ 79
9.1 Private Sector Health Care Providers ................................................... 79
9.2 Private Laboratory ...................................................................................... 83
9.3 Private Health Insurers .............................................................................. 83
9.4 Private Industry ........................................................................................... 85
9.5 Examples of Public-Private Engagement ................................................ 85
9.6 Summary of Key Findings .......................................................................... 86
9.7 Recommendations ...................................................................................... 87
10. Synthesis and Cross-Cutting Recommendations .............. 91
Annex A: Health Systems Strengthening and HIV in St. Kitts
and Nevis............................................................................... 97
Annex B: Validation and Prioritization Workshop
Summary ............................................................................ 101
Annex C: Health Financing Indicators .................................... 117
Annex D: Bibliography .............................................................. 119

LIST OF TABLES
Table 2.1. Income and Inequality Indicators for St. Kitts and Nevis........ 16
Table 2.2. Key service delivery and Health Status Indicators for St. Kitts
and Nevis ....................................................................................................... 17
Table 2.3. Key Actors in St. Kitts and Nevis Health Sector ...................... 20
VI
Table 2.4. Recent International Donor Support in St. Kitts and Nevis .. 22
Table 2.5. Selected Examples of Public-Private Collaboration in St. Kitts
and Nevis ....................................................................................................... 23
Table 2.6. Overview of Existing Capacity for Health System
Strengthening in St. Kitts and Nevis ....................................................... 24
Table 3.1. St. Kitts and Nevis Percentile Rank (0-100) Among all
Countries for Governance Indicators .................................................... 26
Table 3.2. Status of Legislative Updates ......................................................... 28
Table 4.1. Nevis Distribution of Health Budgets ......................................... 43
Table 4.2. St. Kitts Distribution of Health Budgets ..................................... 43
Table 5.1. First Place Visited for Medical Attention by Quintiles
(Percent) ........................................................................................................ 54
Table 9.1. Health Personnel (St. Kitts and Nevis)........................................ 80
Table 9.2. Description of Sample Private Health Insurance Benefit
Package........................................................................................................... 84
Table 10.1. Cross-Cutting Recommendations .............................................. 92
Table A.1. Basic Health Financing Indicators for St. Kitts and Nevis,
2000-2009 .................................................................................................. 117

LIST OF FIGURES
Figure 2.1. Structure of the Ministry of Health in St. Kitts ........................ 18
Figure 2.2. Organogram of the National AIDS Program in St. Kitts and
Nevis ............................................................................................................... 19
Figure 4.1. Total Expenditure on Health as a Percentage of Gross
Domestic Product ....................................................................................... 36
Figure 4.2. Per Capita Total Expenditure on Health ................................... 37
Figure 4.3. General Government Expenditure on Health as a Percentage
of Total Government Expenditure.......................................................... 38
Figure 4.4. St. Kitts and Nevis Annual Budget Process............................... 44
Figure 5.1. Source of Health Services in St. Kitts and Nevis ..................... 50
Figure 7.1. Average Percentage Unit Cost Reduction for a Market
Basket of 20 Popular Drugs 2001/2002 compared with Individual
Country Prices ............................................................................................. 64
Figure 8.1. Organogram of MOH Health Information Unit....................... 73
VII

ACRONYMS
AIDS Acquired Immune Deficiency Syndrome
ART Antiretroviral Therapy
ARV Antiretroviral
BAICO British American Insurance Company
CAREC Caribbean Epidemiology Center
CARICAD Caribbean Center for Development Administration
CARICOM Caribbean Community
CDB Caribbean Development Bank
CDC Centers for Disease Control and Prevention
CHAA Caribbean HIV/AIDS Alliance
CHART Caribbean HIV/AIDS Regional Training Network
CHRC Caribbean Health Research Council
CIDA Climate Change and Environmental Management
CLICO Colonial Life Insurance Company
CMO Chief Medical Officer
CMS Central Medical Stores
CSO Civil Society Organization
DFID United Kingdom Department for International Development
EC European Commission
EC$ Eastern Caribbean Dollar
EDF European Development Fund
FACTTS Facilitating Access to Confidential Testing, Treatment, and Support
FDA U.S. Food and Drug Administration
GDP Gross Domestic Product
HAPU OECS HIV/AIDS Project Unit
HIS Health Information System(s)
HIU Health Information Unit
HIV Human Immunodeficiency Virus
HRH Human Resources for Health
HRIS Human Resources Information System
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HRM Human Resources Management
HRSA Health Resources and Services Administration
HSA Health Systems Assessment
HSS Health Systems Strengthening
HSPA HIV/AIDS Service Provision Assessment
ICT Information and Communications Technology
IFC International Finance Corporation
IT Information Technology
I-TECH International Training and Education Center for Health
JNF Joseph Nathaniel France (General Hospital)
LAC Latin America and the Caribbean
M&E Monitoring and Evaluation
MOF Ministry of Finance
MOH Ministry of Health
NACHA National Advisory Council on HIV/AIDS
NACU Nevis AIDS Coordination Unit
NAS National AIDS Secretariat
NCD Noncommunicable disease
NCI National Caribbean Insurance Company
NGO Nongovernmental organization
NHA National Health Accounts
NIA Nevis Island Administration
NSPH National Strategic Plan for Health 2006-2011
OECS Organization of Eastern Caribbean States
PANCAP Pan Caribbean Partnership Against HIV/AIDS
PAHO Pan American Health Organization
PEPFAR U.S. President’s Emergency Plan for AIDS Relief
PLHIV People Living with HIV
PMTCT Prevention of mother-to-child transmission
PPP Public-Private Partnerships
PPS Pharmaceutical Procurement Service
PS Permanent Secretary
PSA Private Sector Assessment
QA Quality Assurance
X