Control knobs -

Options

Interventions

Solving problems

Stakeholders

Date of

implementation

Evaluation

indicators

1. a) To provide State budget for the Preventive Program for Mother & Child for the year 2002

• Reallocation of funds from other sectors: education and social welfare and labor

Lack of funds

Minister of health, Social welfare and labor and Education – Establish Steering Committee

September 2001

Annual Finical Report

• Provide funds within the Ministry of Health

• Reallocate funds for this Preventive program

100% coverage of the M&C Preventive program by State budget

Establish Coordination Committee

January 2001

Annual Finical Report

• Budget planning and budgetary control in the MOH and HIF

• Enhance revenue and expenditure forecasting for health care, supervision, monitoring

Better allocation of the funds for health care in the MOH and HIF

Monitoring analyzing unit in the MOH

January 2001

Annual Finical Report

• Establish National Account

• Provide complete accurate financial data

HIF

January 2001

b) World Bank Loan – Perinatal Project -

• Procurement of medical equipment for the neonatal units of II and III level, NICU, neonatal transport

Lack of equipment

International Project Unit

May-June 2001

WB standard indicators

• Procurement of computers, Cohraine library, Internet accesses for the neonatal units. Establish network

• Lack of data base
• Lack of information system

Establish Perinatal Committee

End December 2000

WB standard indicators

• Training for health personnel level II and III in the CME Center and overseas

• Introduce CME for doctors and nurses
• Improve training
• Prepare evidence based medicine guidelines and protocols

Coordinator of the CME Center

In progress

OSCE

c) Government budget for the civil works

• Refurbishment of the Pediatric and O&G clinic

Improve the conditions in the health facilities

IPU/MOH

January 2001

Standard procedures

• Refurbishment of the Pediatric: neonatal unit and neonatal transport

Improve the conditions in the health facilities

MOH/IPU

January 2001

UNICEF standards

• Baby Friendly Hospitals

• Refurbishment and equipment for 18 maternity words

Improve the conditions in the health facilities

UNICEF

January 2001

WHO standards

e) WHO

• Health promotion
• CME for patronage nurses

• Lack of knowledge
• Capacity building

MOH

In progress

WHO standards

Japan's Government

• Medical equipment for PHC

Lack of new equipment

MOH

In progress

International standards

2.. Health Insurance Fund

• Budget planning and budgetary control in the HIF

• Enhance revenue and expenditure forecasting for health care, supervision, monitoring

Better allocation of the funds

Monitoring and analyzing unit in the HIF

January 2001

Annual Finical Report

• Improve the collection of contributions

• Increase the efficiency of the control unit: training, information system, incentives

• Capacity building
• Lack of database and information system

IPU/MOH

June 2001

Annual financial and performance review

• Reallocation of funds for prenatal, postnatal and neonatal services

• Include the activities as recommended in the M&C program in the new basic benefit package

Improve the quantity and quality

HIF

March 2001

Passed in the Parliament

3. Community financing

• Prepayment for the rehabilitation of the health facilities

Improve the conditions in the health facilities in rural area

Government Agency for undeveloped communities

March 2001

Agreement achieved

a).Introduce weighted capitation for the PHC doctors

• Financial incentives for doctors – 70% of the income

• Lack of competition among doctors
• Better quality of health care
• Improve consumer satisfaction

MOH

March 2001

Patient list

for preventive activities for PHC doctors

• Financial incentives for doctors – 30% of the income

• Lack of competition among doctors
• Better quality of health care
• Improve consumer satisfaction
• Improve the implementation of the preventive Program for mother and child

MOH

March 2001

Performance indicators

c) Introduce transitional global budgets for the hospitals.

• Simple payment for different service categories based on average costs

• Greater autonomy
• Increased accountability
• Improved quality

Hospital managers

January 2002

Annual financial and performance review

a) To change the Health Care Law

• Give authority to the Doctors chamber for the licensing, accreditation and reaccredidation of doctors

• Lack of accreditation
• Improve licensing
• Improve skills and quality of care

MOH

June 2001

Law passed in the Parliament

• Define the type of services for each type of health organization

• Greater accountability
• Improve the quality and efficiency

June 2001

Law passed in the Parliament

• Introduce compulsory medical audit and peer review

• Improve the quality and efficiency

June 2001

Law passed in the Parliament

• To precise the rights and duties of the patients

• Lack of information
• Greater accountability
• Improve the equity

June 2001

Law passed in the Parliament

a) Regulation for Doctors Chamber

• To issue regulation for licensing, accreditation and reaccredidation of doctors

• Lack of accreditation
• Improve licensing
• Improve skills and quality of care

Doctors Chamber

October 2001

By law issued

c) By-law for the minimum conditions in the health organizations

• Update the current standards in accordance with EU standards

Lack of accreditation for the health facilities

MOH

October 2001

By Law issued

d) By-law for the payment of PHC and hospitals

• Capitation and target performance payment for PHC doctors
• Transitional global budget For the hospitals

• Increased autonomy and accountably
• Lack of incentives

HIF

March 2001

By law issued

e) By law for the basic benefit package

• Basic benefit package constructed and adopted with consensus

Improve equity and quality

HIF

March 2001

By law issued

Health providers

• Define criteria for the contracts with public and private providers

Increased equity for the providers

MOH / HIF

March 2001

By law issued

g) Prepare protocols and clinical guidelines

• Update the current and agree with consensus new protocols and guidelines

Better quality

MOH

September 2001

Published

a) Establish Steering Committee

• To appoint representatives from the Ministry of health, education, finance and social welfare and labor

Lack of intersectional coordination and collaboration

Prime Minister’s Cabinet

January 2001

b) Coordination committee

• To appoint representatives from MOH, Clinical Center, health professionals, MA, DC, journalist

Lack of coordination of the prenatal and postneonatal services, on all levels

Minister of health

January 2001

c) Organize neonatal transport

• Refurbishment completed, equipment installed, staff trained

Better quality of health care

Pediatric Clinic

June 2001

Decreased infant mortality rate

d) Training for health professionals and mangers

• Organize training in health management and financing for the managers
• Organize CME for doctors and nurses in CME Center and overseas

Improved skills and quality of health care

CME Coordinator

In progress

Decreased infant mortality rate

e)Autonomy and accountability of the providers

• Contracts with HIF for the services provided

And competition

MOH / HIF

After adopted by law

Decreased infant mortality rate

a) Program for Public information

• Program for health information of girls and women

Lack of knowledge for the need to use health services

Coordination Committee

March 2001

Increased

• Mass media campaign

Lack of information

MOH

Starting from January 2001

Increased visits

• Health professional health promotion activities

• Lack of knowledge for the need to use health services
• Lack of information

UNICEF

In progress

Decreased IMR

• NGOs

NGOs

In progress

Decreased IMR

b) Community

• Negotiation with the rural community representatives and advocacy of the importance of the recommended activities

Improve the conditions in the rural facilities and quality of the health care

Community

February 2001

Decreased IMR