Download Integración de Sistemas y Servicios

Integration of
Systems and
Services
Operational Experience, MSPAS/IGSS
Escuintla, Guatemala
Background
• 1989 pilot plan by Social Security Institute
(IGSS) to expand coverage based on the
Primary Health Care Strategy.
• MSPAS 1996 Expansion of Coverage and
improved quality of basic health care
services.
Expansion of Coverage
• Strategy to Expand Coverage:
• Proposed as one of the key elements of
the Sectoral Reform.
• Contracts with NGOs for the delivery of
basic health services, as well as
administration of resources still allocated
on the basis of national per capita.
Local Characteristics
• High proportion of the population are direct
recipients or beneficiaries of Social
Security
• Both institutions have extensive network of
services
• Systematic coordination of the
Departmental Bureaus since 1996
• Commitment to the Puerto de San José
Pact
Response
• Proposal to formalize the coordinated work
developed in both institutions
• Proposal to develop the institutional
strategy by both institutions
• Selection of a local administrative/
financing entity
Process
• Beginning of political negotiation process
for both institutions (1 year)
• Harmonization of regulations with the
technical authorities of both institutions (1
year)
• Develop the local validation process
• Raising awareness of the work teams
Process
• Selection and hiring of personnel.
• Development a uniform induction process.
• Development of a systematic horizontal
training process.
• Joint care process begins with the signing
of the agreement.
Key Elements of the Model
• Orientation of Financing
• Regulation
• Control
Progress
•
Provision System:
– Portfolio of Services
1. Reproductive Health Care
2. Pediatric Care
3. Management of Prevalent Diseases
4. Environmental Management
Progress
•
Management System:
– Annual Operating Plan
– Resource management in the service
network
– Health surveillance and risk management
– Development of joint promotion strategies
– Monitoring, supervision, and evaluation
Progress
• Regulation System:
-
Vaccination
Acute respiratory diseases
Acute diarrheal diseases
Tuberculosis
Epidemiological surveillance
Vectors and the environment
Progress
• Information system:
- Weekly, monthly, and bimonthly reporting.
Lessons learned
• The universal provision at first-level of care
in the department improved equity
• Institutional conditions need to be favorable
• Continuing need for negotiation and
lobbying, especially in times of political
transition
Lessons learned
• The model needs a legal foundation.
• It should not be replicated except under
optimal operative, technical, and political
conditions.
• The involvement of operative personnel
improves the likelihood of the model’s
success.
Lessons learned
• A continuous feedback process must be
developed
• Positive reinforcement processes
• Information generated locally must be
analyzed at the local level
• There are no single solutions
Weaknesses
• Little understanding of the model at the
technical and political levels.
• Continued human resource education with
a curative, hospital-centered, biological
approach.
• Centering the model’s promotion activities
exclusively on provider institutions did not
facilitate expansion to other sectors.
Weaknesses
• Scarce information on the model’s
operation disseminated to the local,
institutional, and national levels.
• The strategy for expanding coverage and
the basic package of services does not
recognize the value of promotion and
educational activities.
• Model did not extend to the other levels of
care.
Weaknesses
• Social Security Information System only
partially developed and solely to evaluate
production
Challenges
• Break with the notion that the first level of
care is the same as PHC
• Use the local epidemiological profile to
develop and define the service portfolios
• Influence decisionmakers to ensure the
sustainability of the model
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