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BARBADOS
Trends in Health System Change
and Health Sector Reform
Social and Political Context

estimated mid- year population of 273,018
in 2005
 sustained GDP growth averaging 3% p.a.
 fiscal deficit of 2.5% of GDP
 Per capita GDP of US $7,950 ( 2002)
Social and Political Context
cont’d

Tourism remains one of the main foreign
exchange earners and employers of labour
 International and Financial Business Services
sector is a growing source of foreign exchange
 Construction is buoyant with increasing output
 Agriculture contribution to GDP is declining
although non-sugar agriculture and fishing
increased during the period.
Social and Political Context
Cont’d

Unemployment rate fell to single digits from 2001.
Female participation rate in the labour force has
been increasing
 Adult literacy rate of 99% in 2004. Approx. 66.7%
of persons enrolled in tertiary institutions are
females
 Infant mortality declined from 13.3 per thousand
births in 2002 to 10.1 in 2004, rose to 12.3 in 2005
 Maternal Mortality ratio – one and two maternal
deaths in 2002 and 2003 respectively. Nil in 2004
and 2005.
Social and Political Context
Cont’d
Perinatal mortality is a challenge –
fluctuating between 18.6 in 2003 to 15.8 per
thousand births in 2005.
 Life expectancy at birth – 72.6 years for
men and 78.3 years for women
 1997 Poverty Study found 15% of the
population lived below the poverty line of
BDS $5,503 p.a.

Leading Causes of Death

Disease of pulmonary circulation and other
forms of heart disease
 Cerebrovascular diseases
 Diabetes mellitus
 Ischaemic Heart Disease
 Malignant neoplasms of digestive organs
except stomach
 HIV/AIDS
Leading Causes of Death

Pneumonia
 Hypertension
 Malignant neoplasm of prostate
 Septicaemia
 Acute respiratory infection
 Malignant neoplasm of the female breast
Priorities for Change
Management systems – linking planning
and budgeting cycles; - policy formulation
process that is responsive to globalization
 Financing Systems - provider – payment
mechanisms; cost and management
accounting systems in institutions
 Improving healthcare quality and efficiency
 Improving equity of access

Priorities for Change Cont’d

Health Promotion policy
 Human resource management
 Management information systems
Public Sector Reforms That Impact on
Health Sector Reform

Multi-year budget cycle (three years)
 Accrual accounting to replace cash
accounting
 Information systems policy
 Human resources - performance
management system
Barbados Strategic Plan for
Health 2002-2012

Provides the Health Reform Agenda for the
country
 Identifies the Priorities for Action – these
are in keeping with the Caribbean
Cooperation in Health initiative
 Has become the blueprint in negotiations
and collaboration with donors and other
stakeholders
Health System Changes
Already Being Implemented

Contractual arrangements with non-state
providers with respect to the following
services:
1. Care of the elderly
2. Provision of treatment for drug
abuse
 Autonomy of the Management of the Queen
Elizabeth Hospital
Health System Changes
Being Implemented

Mental Health Reform – the policy
approved by the Cabinet of Barbados places
emphasis on prevention and communitybased treatment.
Health System Change Through Technical
Cooperation

PAHO - BPB
 EU – Sector budget support along with
technical assistance
Technical Assistance to the
MOH includes:

Reorganising and strengthening the steering role
of the MOH
 Strengthening family health services, specifically
initiating interventions in home and communitybased care for the elderly and the disabled
 Reorganising and strengthening health promotion
– policy; management framework which includes
health promotion support unit and implementation
plan.
Technical Assistance to the
MOH includes Cont’d:

Development of information systems to
provide relevant and timely information at
all levels for decision making
- HIS in all institutions
- A central Health Information Unit
- Updated surveillance system
 Development of cost accounting systems
Technical Assistance to the
MOH includes Cont’d:

Development of modern cross-cutting
approaches to the management of CNCDs,
starting with cardio vascular disease.
 Formulation of policies to strengthen human
resource management:- recruitment and
retention; training; job satisfaction;
appraisal.
The End
Prepared by
Samuel Deane
Planning and Research Unit
Ministry of Health
Barbados