Département AFRIQUE

Addressing institutional arrangement bottlenecks for

improved quality care(Examples from

Cameroonian experience)

Ahawo komi M.GTZ Santé Cameroun

page 2 / x

Plan

1.Introduction2.Overview of quality management

actors and instruments3.Institutional links to social

protection4.Institutional bottlenecks and

consequences5.Optimizing institutional link

page 3 / x

1.Introduction

The success of social protection organization (SPO) depends on :political will to establish schemes, purchasing power of the community, perceived quality of care

The Consumer’s trust in SPO is conditioned by his trust in contracting providers.

page 4 / x

2. Overview of quality managment actors

Category Actor Role

Health system Policy makers

Health Administrators

(Provincial and district officers)

elaborate policies, implement reforms and allocate resources

organize, follow and initiate a lot of actions that influence behaviour and practices in the system

page 5 / x

2. Overview of quality managment actors

Category Actor Role

Health system Supply system

Health facility

(health personnel )

Supplies drug and other necessary materials

Health care providers

Other sectors Local government

Finance, influence

page 6 / x

2. Overview of quality managment actors

Category Actor Role

Users Household and communities

Potential, perception of health problems that may be different from expectation

Purchaser Social protection organisms

Finance, influence

page 7 / x

Evidence :Quality care is the result of the interaction of a comprehensive system including all those actors.

2. Overview of quality managment actors

page 8 / x

Quality management tools:

- Accreditation- Guidelines: norms and standards- Systemic quality management(self evaluation, audit, ranking,..) - Monitoring (Bamako Initiative)- Performance oriented contracts etc..- Supervision- Micro insurance Medical advisor

2. Overview of quality managment actors

page 9 / x

Conditions to implement quality management :- Good political will and serious commitment at national level- Decentralization of financial and institutional capacity to improve quality- transparency in the management of the health system- Working as an integrated system- Governance and accountability

2. Overview of quality managment actors

page 10 / x

3. Institutional links to social protection

SPO collaborate with health facilities through

contractingcontractingMost of the time in weakly defined legal and political systems, non-written or incorrectly defined

agreements

page 11 / x

3. Institutional bottlenecks and consequences

Social Protection organizations

Health Facilities

Improved access to quality care

Quality careFinance

Improved health outcome

2. Contracting process

1. Contract

3. Contracting Level

page 12 / x

3. Institutional bottlenecks and consequences

Problems regarding contract conception• lack of specificity,• poor provision in case of non performance..(who will implement the sanctions?)

Problems with relation to the contracting process• insufficient discussion during pre contracting stage (expectations of the personnel, are we following the same goal?)

page 13 / x

Problems with relation to the contracting process• non authorised signatories, (no legal body, no decentralization..)• poor follow up • few interactions or occasions for reviewing and adapting contracts, • insufficient or absence of norms and treatment standards to compare with etc.. • Poor negotiation capacity (Small SPO)

3. Institutional bottlenecks and consequences

page 14 / x

3. Institutional bottlenecks and consequences

Problems with relation to the contracting level• Health facility (difficult to scale up)• District or other level (difficult to implement at local level)• Without administrators, decision makers, suppliers (few possibility of control, sanction application, investment..)

page 15 / x

Evidence

a social protection organization by its self can not sustainably

improve quality of care through contracting with a health facility.

page 16 / x

Optimizing institutional link

•Written contract

•Consider and include other stake holders as witnesses/signatories in contracting negotiations for improved quality care.

•Contract at operational level could be specifications of framework conventions linking decision makers at higher levels with SPO including private insurers.

page 17 / x

•follow up committees of commitments could be created at national and local level and include parliamentarians or local governments members for accountability and compliance.

Social protection organizations should have good size and better institutional capacity to

negotiate good conventions.

Optimizing institutional link comprises

page 18 / x

Murakozi Cyane!