STRATEGIC PLAN 2011‐2015 potx

STRATEGICPLAN 2011‐2015 2 Table of Contents Page MESSAGEFROMTHEMINISTERFORHEALTH………………………………………… 3  FOREWORDFROMTHEPERMANENTSECRETARYFORHEALTH…… 4  INTRODUCTION…………………………………………………………………………… 5 GUIDINGPRINCIPLES……………………………………………………………………  6  Mission  Vision Values  FIJIANDITSPEOPLE…………………………………………………………………  7  HEALTHINFIJI  HealthIndicators………………………………………………………………. 8  SpecificDiseasesandHealthProgrammes………………………… 9  ClinicalServices…………………………………………………………………. 9  HumanResourceDevelopment…………………………………………. 10  Infrastructure…………………………………………………………………… 10  HealthServiceStructure…………………………………………………… 11  HealthCareBudget…………………………………………………………  11  HealthCareFinancingOptions…………………………………………  12  THEPLANNINGCYCLE…………………………………………………………………. 13 STRATEGICGOALS,OUTCOMES&OBJECTIVES,2011/15……………  14–23  STRATEGICPLANWORKSHOPPARTICIPANTSLIST……………………  24‐25 3 MESSAGEFROMTHEMINISTERFORHEALTH   DrNeilSharma  IampleasedtoendorsetheMinistry ofHealth’s Str ategicPlanfor2011to2015.Itdocumentsthe policy priorities the Ministry has set regarding its strategic direction for health care in Fiji for the next5years.  The Strategic Plan has been developed in concert with the Government’s national strategic policy document:the2009–2014RoadmapforDemocracyandSustainableSocio‐EconomicDevelopment. ThetwooverallstrategicobjectivesforhealthintheRoadmapareasfollows:   Communities are serviced by adequate primary and preventive health services thereby protecting,promotingandsupportingtheirwellbeing.  Communities have access to effective, efficient and quality clinical health care and rehabilitationservices.  Thefirstofthesereinforcesourprincipalfocusonprimaryandpreventivehealthcareservicesand thepromotion ofhealth.The second relatesto maintaining effective and efficient qualityandsafe clinicalhealthcareandrehabilitationservices.  The major public health concerns are non‐communicable diseases, emerging and re‐emerging communicable diseases,maternalandchildhealth,mentalhealthandpandemicsorotherdisasters affecting the health and well‐being of thecommunity. There areother environmental factors that haveanimpactonhealthsuchasclimatechangeandtheseneedappropriateconsiderationaswell.  A major focus is to operationalise programs at grass root level in the areas covering MDG 4‐5‐6. Likewise,seriousoperationalprogramstocontrolcommunicablediseaseswillbeaddressed.  Thearenaof NCD needs to be tackled byoverarchingHealthPromotionin its entitywithseedling strategies to address diabetes, hypertension, cardiovascular  diseases and cancer from within the sphere. Greater emphasis on wellness rather than treatment must evolve with High impact, Low technologyinnovations.  Afocusonhumanresourcedevelopmentandstaffretentionwillstillbemaintainedandaddressed indepthtomeettheacuteshortageofhealthprofessionals;asthisisvitaltoensure sustainabilityin the delivery ofhealth services  toour people.Increased on‐going education locallyand abroad will need to be saddled with career orientation for our young workforce to improve on retention strategies.  Customerfocusremainsareasofmajorconcernin2011–2014;increasedoutputfromthemedical andnursingschoolswilladdresssomeoftheworkpressure.  Ithereforeinviteallofourpartnersinhealth;NGO’s,donoragencies,otherministries/departments and the private sector to work closely with the Ministry of Health towards achieving the two strategicobjectivescitedabove.    DrNeilSharma MinisterforHealth 4 FOREWORDFROMTHEPERMANENTSECRETARY FORHEALTH  The Ministry of Health Strategic Plan 2011‐2015 provides the framework for the future planning, managementandservicedeliverybytheMinistryofHealthtoaddresssevenHealthOutcomes.  ThesesevenOutcomesarederivedfromthetwoStrategicObjectivesspeltoutintheGovernment’s 2009–2014RoadmapforDemocracy &SustainableSocio‐EconomicDevelopment.Andwithinthose HealthOutcomeswehaveidentifiedseveralfocusareasthatwewillbespecificallytargetinginthe next5years.  ThePlanreinforcesthevisionofGovernmentthatPrimaryHealthCareorPreventiveHealthshould betheprimarilyfocusoftheMinistry inaddressing itscorebusinessofmaintaininggoodhealthand wellbeingofthecitizensofFiji.  Needlesstomention,ClinicalServiceswillbealsofurtherdevelopedandstrengthenedthroughthe implementationoftheClinicalHealthSe rvicesPlantomeetthehealthcareneedsofthepopulation. Thiscommitmentismadein viewofthecurrenthighdemandforqualityhealthservicesprovision. Moreover,fromourpresentdiseaseburdentrendsespeciallywithnon‐communicablediseases,up scalingofclinicalserviceswillneedtobeundertaken.  The provision of adequate and appropriate resources is vital to ensure the sustainability of the  deliveryof healthservicesto ourpeople.In this regard,theneedto have evi dence based decision making is essential in guiding the Ministry’s way forward. To this end, the strengthening of the HealthInformationUnitandtheestablishmentoftheHealthcareFinancingUnitarestrategiesthat theMinistryhasputinplace.   At this point, I must sincerely thank all those that participated in the formulation of the Strategic Plan 2011‐2015 for Proverbs 24:6, “For waging war you need guidance, and for victory many advisors”isappropriateinthiscase.Werecognisethisspiritualtruthinthatthereisakey roleother stakeholdersplayinoureffortstowinningthiswaragainstinfirmity,sicknessanddisease.   I acknowledge that while the challenge before us is immense I am fully pursuaded that by God’s gracewearemorethanconquerorsthroughChristwholovedus.  I therefore take this opportunity to call  on every responsible citizen in Fiji  to help and assist the MinistryofHealthinfulfillingitsdivinepurposeinshapingFiji’shealthtoachieveabetteroutcome inthesenextfiveyears.     DrSalanietaSaketa PermanentSecretaryforHealth 5 INTRODUCTION  This document is a statement of intent by the Ministry of Health on how it wants to address crucial health and health related issues in the country over the coming five years.Indevelopingitsobjectivesandtargets,theMinistryofHealthtookitscuefrom the two principal overarching Strategic Goals from the Government’sRoadmapfor DemocracyandSustainableSocio‐EconomicDevelopment2009 –2014and the seven HealthOutcomesthathavebeencarriedforwardfromtheMinistry’s 2007 – 2011 StrategicPlan.  Itisworthemphasisingherethat,inaStrategicPlan,the“targets”mentionedaboveare not deliverables as such; they are situations to “aim” at, not necessarilyresultsto achieve.ItistheMinistry'sAnnualCorporateand,withintheMinistry'soperationsthe DivisionalandothersectionalBusinessPlans,thatcontainparticularkeyresultswhich aretheretobeactuallyachievedanddeliveredintheyear.  The Ministry also took into consideration the Millenium Development Goals [MDG’s] anditisalsoworthnotingthatwhiletherearethreeMDG’sdirectlyrelatedtohealth [MDG’s4,5&6]therearealsotwootherMDG’sthathavehealthrelatedcomponents, whichareMDG’s1&7.  ThisStrategicPlanhasseenitfittoincludeathirdStrategicGoal(Outcome)tocapture thoseobjectivesthat,eventhoughtheyrelateindirectlytothesevenHealthOutcomes, areofequalimportanceinprovidingrelevancetotheMinistry’sstrategicplan.  Manyofthestrategicobjectiveswillrequirepartnershipswithandthecollaborationof other organisations including non‐government organisations, donors and other governmentdepartments.Thesepartnershipsandthecollaborationsareallvery importantandithasbeenthereforeveryencouraging,duringtheprocessofdeveloping thisstrategicplantohavehadinputfrommanyofthosepartners and collaborators, includingtheirparticipationatthe2011/15StrategicPlanWorkshopheldon11 th and 12 th Augustof2010.  This Strategic Plan establishes and confirms the strategic intentthatitisPrimary HealthCare,includingPreventiveHealth,thatshouldbethefirstandprincipalfocusof the Ministry over the next five years, in addressing the healthandwellbeingofthe citizensofFiji.Clinical serviceswill be also further invested in, developed, improved andstrengthenedthroughtheimplementationoftheMinistry'sclinicalhealthservices planning,inordertomeetthehealthcareneedsofthepopulation.  6 GUIDINGPRINCIPLES  TheguidingprinciplesfortheMinistryofHealthare:‐  Vision AhealthypopulationinFijithatisdrivenbyacaringhealthcaredeliverysystem.  Mission Toprovidehighqualityhealthcaredeliveryservicesbyacaringandcommitted workforce with strategic partners, through good governance, appropriate technology andappropriateriskmanagement,facilitatingafocusonpatientsafetyandbesthealth statusforallofthecitizensofFiji.  Values CustomerFocus Wearegenuinelyconcernedthathealthservicesarefocusedonthe people/patients receivingappropriatehighqualityhealthcaredelivery.  RespectforHumanDignity Werespectthesanctityanddignityofallweserve.  Quality Wewillalwayspursuehighqualityoutcomesinallouractivitiesanddealings.  Equity Wewillstriveforequitablehealthcareandobservefairdealingswithourcustomersin allouractivities,atalltimes,irrespectiveofrace,colour,ethnicityorcreed.  Integrity Wewillcommitourselvestothehighestethicalandprofessionalstandardsinallthat wedo.  Responsiveness We will be responsive to the needs of the people in a timely manner, delivering our servicesinanefficientandeffectivemanner.  Faithfulness We will faithfully uphold the principles of love, tolerance and understanding in all of ourdealingswiththepeopleweserve.       7  FIJIANDITSPEOPLE The Fiji Islands are a republic comprised of greater than 300 islands covering more than18,000squarekilometres.Thenatureofthisgeographyposes significant challengesforthedeliveryofhealthservicestothepopulationthataredispersedover suchalargemaritimeregion. The 2007 census placed Fiji’s population at 837,271 (for government planning purposesthesearedividedintofourdivisions;Central‐withapopulationof342,477, Eastern ‐ with a population of 39,313, Northern ‐ with a population of 135,961 and Western ‐ with a population of 319,611). The total rural population was 412,425 or 49.3%ofthenationalpopulationwithtotalurbanpopulationat424,846–50.7%ofthe nationalpopulation. 1 ThetrendrevealsagrowingurbandriftinFiji’spopulation.  ThemajorsourcesofincomeinFijiarederivedfrom:  Tourism  Sugar  Mining  Fishing  Forestryand  Remittances. 1 2007 Fiji Population Census, Fiji Island Bureau of Statistics [FIBoS] 8 HEALTH IN FIJI  HealthIndicators  The improvement of people’s healthisanintegralpartofthesocioeconomic developmentofthecountry.  Recognising Millennium Development Goals (MDGs) are intended as global targets, somecountriesmaynotbeabletoachieveallofthembytheyear2015.Thisincludes Fiji.  Overall,theprogresstowardsachievingtheMDGsinFijiisprogressingonincremental basis;however,theyarenotsufficientenoughtomeetthetargetsbytheyear2015.In theareaofHealthrelatedMDGs4,5and6,Fijiisfacingmajorchallengesinachieving keytargets.Someofthecontributing factors include staff shortages, insufficient monitoring of pregnancy related illness, cost of health services to allow poor to take advantage of available health facilities and the need to strengthen health system throughimprovinginvestmentintechnicalinfrastructures 2 .  TheindicatorsforMDG4showthatinfantmortalityratehasdeclinedbyabout 23% overthepast20yearsbutitwouldneedtodecreasebyafurther57%overthenext5 years 3 .Themajorcausesofmortalitiesincludeperinatalconditionssuchasbirth asphyxia,congenitalmalformations,sepsis,under‐weightandcongenitalsyphillis 2 .  Likewise, achieving the targets of MDG 5 needs to be addressed comprehensively. While proportion of deliveries by skilled health personnel has been fairly high throughoutthe1990to2008periodandthematernalmortalityratiodeclinedby23%, thiswouldneedtodecreasebyafurther68%tomeetthetarget 3 .Thereisalsolackof dataonadolescentbirthrateandunmetneedforfamilyplanningformostyears. 4 The contraceptiveprevalenceratehasalsoremainedlowbetween35%and49%from2000 to2008averagingaround40% 2 .  AlthoughtheprevalenceofHIV/AIDSislessthan0.1%whichislow by international standards,thecumulativeincidenceisrisingrapidlyandstoodat333confirmedcases inDecember2009comparedto4in1989. 2 Thereportedcasesaremainlyamong30‐39 and40‐49agegroups.ThereisindeedaneedtoaddresstheexponentialtrendinHIV cases.WhileMalariaisnotahealthissueinFiji,theincidenceofTBandprevalenceof TBhasdeclinedovertheyears.  Whilsttherehasbeenadeclineintheincidenceofsomeofthecommunicablediseases over the past 20 years such as tuberculosis and filariasis, the rise in incidence of Leptospirosis and typhoid fever inrecentyearsisacauseforconcern.  The growing burden of non‐communicable diseases is demonstrated by the NCD STEPS Survey of 2 Ministry of National Planning, MDG Report 2 nd Report, 1990-2008, 2009 Report for the Fiji Islands 3 Health Information Unit Database, Ministry of Health 4 World Bank, 2008; MDG Report 2 nd Report, 1990-2008, 2009 Report for the Fiji Islands 9 2002whichreportedaprevalencerateofDiabetesat16%andHypertensionas19.1%. Thereportalsohighlightedthatathirdofalldeathswereduetocirculatorydiseases. 5  6   An assessment of Fiji’s progress towards achieving its health outcomes depends on a wellfunctioninghealthinformationsystemwithaccesstoage,sex and geographical, timeseriesdisaggregateddata,someofwhichwerenotavailable.Effortsarebeing made to address the data gaps to enable planning for preventionandresponseto emerginghealthissues.  SpecificDiseasesandHealthProgrammes  The triple burden of communicable diseases, non communicable diseases[NCD]and injuries has been plaguing the health system in Fiji. 7 TheprematurityofNCDdeaths especially is becoming an economic and development issue, as the age of men dying from CVD falls every year. In a 2002 study carried out by the World Bank and the SecretariatofthePacificCommunity(SPC),itwasrevealedthat38.8%ofalltreatment costswereattributedtoNCDand18.5%tocommunicablediseases.  The threat of emerging and re‐emerging communicable diseases, like TB, SARS, and avian influenza (HPAI H5N1), that pose international threats and would have socioeconomic impacts on Fiji has highlighted the need for vigilance in surveillance, bordercontrol,detectioncapacity,investigationcapacityandcapacitytorespondina timelyandcoordinatedmanner.  ClinicalServices  Therehasbeenafundamentalshiftinlifestylesoverrecentdecades,andthedecrease indeathsfrominfectiouscauseshasbeenpartlycounteredbyincreased deaths from degenerativeandchronicdiseases,principallydiabetes,circulatorydiseasesandcancer. There is an increased vulnerability to poverty. Many rural people have migrated to town, and many skilled people overseas. Obviously, all this hasbeenfeltatboth outpatientandinpatientservicesinthehospitalsettingtovariousdegrees.  Demandonoutpatienthospitalserviceshasbeensuchthatithasledtoanunevenload with generally over‐utilised resources at the divisional hospitalsattheexpenseof urban and peri‐urban health centres.Astrategytocounterthistrendhasbeento extendopeninghoursatselectedhealthcentres,whichhasseen improved results in reducedwaitingtimes.  Hospitalcareofpatientshavechangedin thelastdecadesbecauseoftheincreasesin admissions and the occupancy rates, especially in the 3 divisional hospitals, with resultantincreasesintheaveragelengthofstay[ALOS].  5 Ministry of Health Annual Reports 2002-2008 6 Health Systems in Transition The Fiji Islands, Health Systems Review. Vol.1 No.1 2010 (unpublished) 7 2007 Fiji Situation Report 10 TheMinistryofHealthhasdevelopedaClinicalServicesPlan,which provides the frameworkinwhichtostrengthenitsclinicalservicesatalllevelsofcare.Partofthis initiative has seen the formation of Clinical Service Networks [CSN’s] of the various disciplines – Obstetrics & Gynaecology, Paediatrics, Surgery/Orthopaedics, Anaesthesia/ICU, Internal Medicine, Oral Health, Ophthalmology and Mental Health, PublicHealth,Radiology,PathologyLaboratoryandOncology.  Introduction of new services include Cath lab services at CWMH,introductionofCT scanservicesatLautokaandLabasahospitals,whilethenewEyeClinicatCWMHseean expandedophthalmologyserviceinoperation.  TheLaboratoryInformationSystem[LIS]isscheduledtobesetupin2011andwilladd anewdimensiontoPATIS,somethingwhichhasbeenlongoverdue.Consequentlythis will,nodoubt,improveclinicalservices.  HumanResourceDevelopment  TheMinistryofHealthisawareofthecriticalneedtoaddresshumanresource development because of its key strategic role in the effective deliveryofhealthcare services.  StaffretentionisamajorchallengefortheMinistryofHealthanditiscommittedtosee that capacity building is implemented across all levels to ensureskillslevelare maintained at an acceptable level that will enable it to continue to provide quality healthcareservicestothepeopleofFiji.  Aspartofaconcertedeffort,theMinistryhaslookedtoincreasingitsintakeoftrainee doctors and nurses while revising bonding conditions and introducing annual registrationofhealthprofessionalsandcompulsorycontinuedmedicaleducation.  On this note, it is important to record that medical education in Fiji reached a new chapterinitshistorythroughtheopeningofaprivatenursingschoolinLabasain2005. AmedicalschoolwasopenedattheUniversityofFijiin2008andmorerecentlyGovt reformsledtotheFijiSchoolofNursingandtheFijiSchoolof Medicine merging to becometheCollegeofHealthSciencesunderthenewlyformedFijiNationalUniversity in2009.  Theexpectedgraduatesfromtheseinstitutionsinthenextseveralyearsshouldseean influxthatforthefirsttimeintwodecadescouldwellbebeneficialtothecountry.  Infrastructure  TheMinistryofHealthhasendorsedtheSafeHospitalsconceptinlightoftheexposure ofhealthfacilitiestonaturaldisasters.Theconceptlooksatensuringthatappropriate facilitiesareavailabletoenablesafedeliveryofhealthservicestothecommunities.At thesametime,intermsofdisasterpreparedness,theMinistryhasdevelopedaNational DisasterManagementPlanforthepurposeofeffectiveandefficientresourceutilisation.  [...]... annual plan results but also the progress towards the strategic objectives (targets), outcomes and goals in the Strategic Plan This latter, in turn, informs the next five year strategic plan STRATEGIC PLAN 5 year CORPORATE PLANS Annual Annual PERFORMANCE INDICATORS ACHIEVED OR UNACHIEVED Business Plans Business Plans 13 STRATEGIC GOALS, OUTCOMES & OBJECTIVES It is important that all of the strategic goals and objectives in this plan are understood... Framework to enable it to identify possible areas for re‐prioritisation purposes THE PLANNING CYCLE Described as a “Planning Cycle”, the planning process that the Ministry of Health employs can be shown by the following diagram It involves 5 year strategic planning, annual corporate planning and internal business planning It also involves the management required to achieve the results planned in the annual business and corporate plans, including the financial plans Further,... Health outcome 7: Improved environmental health through safe water and sanitation 14 STRATEGIC GOALS, OUTCOMES & OBJECTIVES The following has as its two principal headings the Ministry's two overall Strategic Goals Under each of these are listed the respective ones among the seven established MoH Health Outcomes (from the 2007/11 Strategic Plan) ; and against these are grouped the relevant Objectives from the Health... time ago, agreed the 7 Health Outcomes that it would focus on These are in the nature of areas of or groupings of objectives Consequently all of the strategic objectives contained in this plan are, wherever possible, grouped under those stated 7 Health Outcomes The third strategic goal on strengthening the health system provides objectives, which contribute variously to the 7 health outcomes The 7 Health Outcomes...There are plans to construct new hospitals in Navua, Ba and Nausori while the establishment of a regional mental health institution has already been endorsed by Cabinet and funding arrangements are being looked at These major capital projects, together with plans for the introduction of new services in the divisional hospitals based on the Clinical Services Plan, will mean new infrastructure and facility developments taking place in the next several years... Prevention Strategic Plan 2007 – 2011  Increase the number of personnel trained in mental health  Provide accessible mental health services in all divisions Health Outcome 7 Improved environmental health through safe water and sanitation Objective 7.1  Increase the proportion of people with access to safe water Objective 7.2  Increase proportion of people with access to safe sanitation STRATEGIC. .. activities such as cleaning, laundry, kitchen and security Health Planning and Infrastructure Indicator Objective 8.8  Health Policy Commission Unit established  75% of capital projects completed with documentation Objective 8.9 (Monitoring and Evaluation Indicator)  Strengthening the monitoring and evaluation framework 23 STRATEGIC PLAN WORKSHOP PARTICIPANTS LIST Name  Dr Neil Sharma  Dr. Salanieta Saketa ... Programme Administrator  Short Term Advisor  Acting Head of School  Fiji School of Medicine  Fiji School of Medicine  Strategic Framework for Coordinating Change Office,  PM’s Office   Public Service Commission  Ministry of Finance   Ministry of Finance  Ministry of National Planning  Ministry of National Planning   NHIM, Global Fund  World Health Organisation (WHO)   WHO  WHO  WHO  JICA Representative  UNICEF Pacific ... STRATEGIC GOALS, OUTCOMES & OBJECTIVES It is important that all of the strategic goals and objectives in this plan are understood to be the outcomes, or impacts, that are desired over this five year period These are therefore described in outcome terms; that is as situations or states of being that are being aimed for Although there is some discussion in this plan of the methodologies which may be used to move towards the targets the... The establishment of a Health Care Financing Unit is part of the Ministry’s strategic efforts to ensure it is able to identify gaps in the system and how to address them and also find out ways to have cost effective programmes  New sources of revenue generation  Cost reduction strategies such as natural energy sources 8 NHA 2007 - 2008 12 The Ministry of Health is very keen on creating fiscal space to enable it to achieve its strategic objectives In this case, it is looking at a Mid‐Year Term Expenditure . annual plan results but also the progresstowardsthe strategic objectives(targets),outcomesandgoalsinthe Strategic Plan. Thislatter,inturn,informsthenextfiveyear strategic plan.  . Annual Annual STRATEGIC PLAN CORPORATE PLANS Business Plans Business Plans PERFORMANCE INDICATORS ACHIEVED OR UNACHIEVED 14 STRATEGIC GOALS,OUTCOMES&OBJECTIVES . Describedasa“PlanningCycle”,theplanningprocessthattheMinistry of Health employscanbeshownbythefollowingdiagram.Itinvolves5year strategic planning, annual corporate planning