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BUILDING PARTNERSHIPS FOR HEALTH SYSTEMS STRENGTHENING

BUILDING PARTNERSHIPS FOR HEALTH SYSTEMS STRENGTHENING. Partnership between the Government of Lesotho and CHAL B.B.P. RAMASHAMOLE. INTRODUCTION.

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BUILDING PARTNERSHIPS FOR HEALTH SYSTEMS STRENGTHENING

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  1. BUILDING PARTNERSHIPS FOR HEALTH SYSTEMS STRENGTHENING Partnership between the Government of Lesotho and CHAL B.B.P. RAMASHAMOLE

  2. INTRODUCTION • The Christian Health Association of Lesotho (CHAL) is a voluntary association of Christian churches providing not-for-profit health care services to the Basotho. • CHAL made up of six member churches • Operating 8 hospitals and 72 health centers. • Serves 40% of the population of Lesotho especially in the mountain areas.

  3. Government of Lesotho (GoL) and CHAL have been partners for quite sometime. • Most of the agreements were of short-term nature. • In 2002 the two partners signed another short-term agreement, Supplementary Emergency Financing Facility (SEFF). • Implemented 2003/04 – 2004/05 • Intension was to ensure that CHAL institutions were financially sound while preparations were under way for a long time agreement.

  4. The agreement is commonly known as Memorandum of understanding (MOU) between CHAL and the Government. • MOU was intended to begin during the financial year 2005/06. • Negotiations and other preparatory work for implementation of MOU took longer than was anticipated. Hence implementation kick started in January 2008.

  5. ORGANISATIONAL STRUCTURE OF MOU • Cabinet of the Government of Lesotho. • Sub-Committee of Ministers and Heads of CHAL member churches. • Joint Commission of Cooperation (JCC) • JCC sub Committees (Quality Assurance, Human resources, Finance Management, Legal, and Infrastructure). • Sub committees report to the JCC through its technical arm termed the Working Committee.

  6. MAJOR ROLE PLAYER IN THE IMPLEMENTATION OF MOU • JCC is the major decision making body. • Composed of both CHAL and GoL delegates. • Oversees overall implementation of the MOU. • Establish different sub-committees as per need. (Recent Infrastructure). • Monitors the partnership through its sub-committees.

  7. Advises sub-committee of Ministers and Heads of churches. • Sets policies that govern the partnership.

  8. AGREEMENT • The major purpose of the agreement was that the Government purchases essential services (Essential services package agreed upon) plus certain specialized services stipulated under the Letter of Intent. • Family Planning services are provided by all member churches, except that RCC advocates only Natural Family Planning. • The two partners are bound by the agreement and its annexes and it is enforceable by Law.

  9. CONDITIONS UNDER THE MOU • The board of CHAL incorporates three representatives as members. • At district level, CHAL hospitals’ boards include a Government representative as a member. • All CHAL institutions governed by the National Health and Social Welfare policies, guidelines and protocols.

  10. Certification of CHAL institution and Accreditation of Government institutions. • Intended to ensure that services procured by government are of good quality, assess the level of services provided by Government institutions, and to generally scale up service provision by both partners. • The process given three rounds.

  11. For CHAL institutions to continue being financed at the end of the third round, they should meet the set standards under the process. • Submission of audited financial reports, done by external auditor (end of June) for budgeting and performance analysis. • Proper and timely reporting by CHAL institutions • Funds received from government be banked in local registered financial instit.

  12. Proprietors finance 20% of the institutions total allowable operating expenses. • Government subvention and user fees collected • Proprietors sign Letters of Intent with CHAL Secretariat. • Institutions resources allocation determined through agreed mechanism (Funding formula). • Both CHAL and government user fees be the same.

  13. PREPARATORY WORK PRIOR TO IMPLEMENTATION OF MOU • Development of performance standards to used under certification/accreditation. • Standardization of user fees (No charges at health centre level, Similar prices in both CHAL and Government hospitals. • Classification of surgical procedures (their fees indicated under the standard user fees structure)

  14. Classification of institutions according to their level of services (typology). • Determination of minimum staffing pattern per type of institution given the projections of expected patients. • Revision of standard treatment guidelines. • Development of essential drug list. • Development of standard equipment list. • Revision of financial reporting formats. • Determination of the funding formula.

  15. THE JOURNEY SO FAR • SOME OF THE ADVANTAGES REALISED • More HIV & AIDS patients being enrolled into ART programmes. • Infants treated in large numbers. • Access to health services in general increased. • Significant shift in services requirement from hospitals to health centers.

  16. KEY CHALLENGES • Staff burnout (Shortage in required manpower, especially nurses). • Infrastructure requirement. • Patients preference of CHAL institutions over Government’s. • Shortage of drugs from the supply side and long delivery chains. • Abrupt increase general price level during 2008/09 financial year.

  17. CONCLUSION • The partnership arrangement is quite open during this time of transition (shortages of financial resources for unforeseen circumstances claimable). • Government procedures in resource disbursement take a long time. • The partnership would be a breakthrough in rolling out health services and their sustainability in the future.

  18. The coming financial year 2009/10 would provide a better picture of where the agreement is headed.

  19. THANKS KEA LEBOHA

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