Département AFRIQUE
Addressing institutional arrangement bottlenecks for
improved quality care(Examples from
Cameroonian experience)
Ahawo komi M.GTZ Santé Cameroun
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Plan
1.Introduction2.Overview of quality management
actors and instruments3.Institutional links to social
protection4.Institutional bottlenecks and
consequences5.Optimizing institutional link
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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.
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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
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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
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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
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Evidence :Quality care is the result of the interaction of a comprehensive system including all those actors.
2. Overview of quality managment actors
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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
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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
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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
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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
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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?)
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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
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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..)
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Evidence
a social protection organization by its self can not sustainably
improve quality of care through contracting with a health facility.
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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.
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•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
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Murakozi Cyane!