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Mr. Juan Esteban Peguero Mateo

Strengthening the Steering Role and Implementation of the Sectoral Policy in the Dominican Republic. Ministry of Public Health and Social Welfare. Mr. Juan Esteban Peguero Mateo Bureau of Health Planning and Systems, Ministry of Public Health and Social Welfare (SESPAS) Dominican Republic.

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Mr. Juan Esteban Peguero Mateo

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  1. Strengthening the Steering Role andImplementation of the Sectoral Policy in the Dominican Republic Ministry of Public Health and Social Welfare Mr. Juan Esteban Peguero Mateo Bureau of Health Planning and Systems, Ministry of Public Health and Social Welfare (SESPAS) Dominican Republic

  2. Dominican Republic

  3. General Information on the Dominican Republic • Population (2007) 9,224,428 Male 49.8% Female 50.2% • Area 48,442 kms2 • Population density 190 inhabitants per kms2 • Territorial division: 1 national district and 31 provinces

  4. General Information (continued) • 2007 national budget: RD$258,479.55 million • SESPAS health budget: RD$17,321.92 million • Equivalent to: 6.70% of the national budget 1.72% of GDP

  5. Contents • Background • Baseline • Current Situation • Organic and Functional Challenges

  6. Background • State reforms (the 1980s and 1990s) in the countries of Latin America and the Caribbean • Initial reform efforts: In the Dominican Republic, the reform process started in the 1990s

  7. Baseline The new legal framework: 2001 Steering role and development of theessential public health functions (EPHF) Law 42-01 • Financing of the National Health System Law 87-01 • Administration of risk • Delivery

  8. 2001-2007 National health policies defined and regulations established. Regulations of the General Health Law: Regulation of the steering role and the separation of functions Commitments to the Millennium Development Goals Strategic Agenda for Health Sector Reform Preparation of the 10-Year Health Plan with broad social participation Definition of a new care model based on organization of services networks and strengthening of primary health care Legal Framework

  9. Strategic Areas of Health Sector Reform • STRENGTHENING OF SESPAS STEERING ROLE WITH AN EMPHASIS ON THE EPHF • ORGANIZATION AND STRUCTURING OF PUBLIC NETWORKS OF REGIONAL-LEVEL HEALTH SERVICES PROVIDERS • GUARANTEE OF EQUITABLE ACCESS TO SAFE, GOOD QUALITY, AND EFFECTIVE DRUGS. • GUARANTEE OF INSURANCE, WITH AN EMPHASIS ON THE LOWER-INCOME POPULATION.

  10. Strategic Areas of the Health Sector Reform • DEVELOPMENT OF HUMAN RESOURCES IN THE HEALTH SECTOR. • DESIGN AND IMPLEMENTATION OF THE GENERAL INFORMATION IN HEALTH

  11. STEERING ROLE Direct exercise of nondelegable substantive responsibilities pertaining to the HEALTH AUTHORITY CONDUCT/LEAD FINANCING Policy Economic (Power, Governance) (Industry, Economic Interest) REGULATION INSURANCE Health Authority DELIVERY OFSERVICES EPHF Social (Citizens’ right) Exclusive functions Shared functions

  12. Conduct/Lead Function It is a responsibility of the highest health authority and is the central function of the steering role. It guides the institutions of the sector and mobilizes actors and social groups in support of national health policy. It defines the capacity of the national health authority to manage strategic health plans and policies through the definition of National Health Plans and the assessment of the performance of health systems.

  13. Strategic Actors Steering Role CNSS (National Social Security Council) CNS (National Health Council) Social Cabinet SESPAS COSENASA (National Health Insurance Council) WATER SECTOR Administrative council Service providers

  14. Advances in Carrying Out the Steering Role Function

  15. Start of the process of separating the functions of steering, insurance, delivery of services, and financing of the National Health System, as established under the new legal framework

  16. Advance toward institutional reorganization of management of the sector and effectively exercise the steering of the National Health System, both at the central and decentralized levels, creating the: • National Health Accounts Unit • Sectoral Health Analysis Unit • Bureau for Certification and Accreditation of Health Services

  17. Creation of an entity to monitor and evaluate the Mobilization and Zero Tolerance campaign; follow-up and control of principal public health problems • National mobilization for discussion and approval of the 2006-15 National Health Plan • Active participation of the SESPAS in the National Health Council, National Social Security Board, and other coordination opportunities such as working and consultative groups to meet the Millennium Development Goals and other items on the national health agenda

  18. The greatest success achieved by the National Health System of the Dominican Republic in the last three years is implementation of the Dominican Social Security System, which has benefited 2,689,115 persons, equivalent to 29% of the population. Of those, 987,115 Dominicans classified as poor correspond to the subsidized system, and 1,702,000 workers correspond to the contributory system through the implementation of family health insurance.

  19. Challenges in the Health Sector 2006-2015

  20. Overcome theaccumulated social debt and complete the unfinished agenda Development of theNational Health System Face new challenges Protect achievements attained

  21. Intensify development of the regional health services network model, which is in the process of implementation through the strengthening of the organizational and managerial structure, until decentralization and functional autonomy is attained

  22. Increase the effectiveness and impact of the National Health System, developing a comprehensive care model, with sufficient coordination between public health and care based on the primary health care and health promotion strategy • Ensure adequate and sustainable financing for the subsystems, gradually increasing public spending on health up to 5% of GDP

  23. Achieve universal coverage of the entire population with the family health insurance of the Dominican Social Security System • Advance with modernization of the administrative and financial management of the SESPAS and other health sector institutions • Ensure better development of human resources for health • Strengthen citizen participation and the intersectoral approach in health management

  24. Reduce the accumulated social debt, as well as social and gender inequities and inequalities in health • Coordinate the health sector with processes of sustainable human development and manage it as a National Health System, through the coordinated development of its functions and subsystems according to principles and strategies established in the General Health Law (42-01) and its regulations

  25. Intensify modernization and institution- building of the SESPAS at the central and decentralized levels (Provincial Health Bureaus, DPS) in order to effectively take on governance functions of the National Health System • Relaunch and develop the primary health care strategy in order to strengthen the first level of care

  26. Thank you very much …!!!

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