 Hello and welcome to HealthFocus, a production of the Ministry of Health and Wellness. I am Phenyleptin. Today we have with us the coordinator of the performance-based financing under the Health System Strengthening Project, Mr. Neham Jabatis. Welcome. Thanks for having me. Wonderful. Okay, so today we'll be talking about the performance-based financing. What exactly is this? Okay, performance-based financing is a new approach for us in delivering services. What is done is that benefits are offered to two sets of people. To the persons who provide the service and to the persons who receive the service. The whole intent or the goal of all of that is for you to have increasing service, but you also have increasing outcomes or what you are supposed to provide for the client. So this is a new approach relatively. Albeit it's not new in terms of for years the Ministry of Health has been trying to implement health reform. And this is, if you want, a very good way to demonstrate health reform. So it comes timely for us. That's what it's all about. Okay, so what would you really say is the objective of this? Okay, so the objective of this is, let's take it from the impact of it. First of all, we want to reduce mortality from communicable diseases. In our case we are focusing on diabetes and hypertension. So this would be the overall goal to reduce mortality and also if you want consequences of diabetes and hypertension. You mentioned two key things. But before we go into that, can you speak as it relates to your role in this whole performance-based financing? Okay, so my role is to work with, to coordinate, to work with some of the existing structures that we have to tackle diabetes and hypertension in the country. And to introduce this new concept of performance-based as a strategy for providing the services to make it more efficient and effective. So I would be working with some of the key departments that provide the service. And I could mention them here, the community nursing service, because the whole system is based in the primary care setting. I also have to work with the epidemiology department because they would be assisting in providing information. I have to work with the planning department of the ministry because they were responsible in conceptualizing it. And of course I also have to work with some of the people at the level of policy because as I said, it would require a whole change in the reform. So we also have to look at some of the policy issues involved as well. Okay, and you mentioned reform, and it has to do with the policy. But what are some of the key areas? I know you mentioned diabetes, NCDs. Are there any other areas that it also focuses on? Right, so for this, I think if you would allow me, if you just bear me, let me just put this into the context. Why diabetes and hypertension? So the project itself is, there are four components of this big health system-transplanting project. The first, one of them is to provide an essential, in fact the second component is to provide an essential package of services. And what this does is it would select a set of services that the government or that the government or it might be another institution would provide financing for. So you have to, right now the ministry is going through the process of selecting those services. And it isn't visage that diabetes and hypertension will be part of these services. Why? Because it's responsible for about 75% of the deaths we have. So in essence, this pilot project is part of an essential package of services of which diabetes and hypertension will be in. But there will be others to come down the road. And what we'll be doing is providing this service through the approach of performance-based financing. As I mentioned, we're going to provide incentives to persons who provide the service and also benefits to persons who use the service. So basically it will be helping the delivery of services as it relates to health. Yes, yes. And you mentioned incentives. What are some of the incentives under this performance-based financing? So there are two sets of people receiving incentives. One would be the, let's look at the most important persons, the clients. So the clients would receive free, for now they would receive free laboratory testing. And the persons who provide the service, what they would do? They would be receiving additional funds, which they could use under agreed conditions based on their performance. So if for example we set a target and then they have achieved the target or surpassed the target, we're going to reward them or provide them incentives so that they can use that service to enhance the services, maybe to train their staff or to do other things. So in a sense, that's how we are trying to see how we could get two things. For persons to use the services a lot more, but also for us to provide more quality and efficient services for persons with diabetes and hypertension at this time in the country. Great. And who would you say the incentives actually cater to? So they cater for now under the program for diabetes and hypertension. They would be catering for the persons with diabetes and hypertension, the persons who we have to screen for diabetes and hypertension as well, and also the persons who provide the services for diabetes and hypertension. So hopefully we would cover everybody who is supposed to provide efficient and effective services with respect to diabetes and hypertension in the country. And at the end of the day we hope to cover everybody, but for now we're going to pilot it in some of certain key areas where we see for example the prevalence of diabetes and hypertension is higher or where we see we can achieve results much quicker to bring other people on board and so that's how we are hoping to move forward. Wonderful. Well, we are due for a break. We'll be back in a moment. And flourish in time. Hold on a little longer. Life encourages you to grow. You have so much to offer. Look, tomorrow is waiting to say hello. Don't give up on yourself. Instead, reach out for help. Perhaps it's time to reach out to someone. Call the Health Helpline 203 toll-free anytime to speak to a professional. A message from the Ministry of Health and Wellness. Welcome back. We will continue our discussion with Mr. Neyem Jebatis. Thank you. Okay, before we took the break, you started speaking a little bit. You mentioned the incentives and who does it cater to. But I would like you to touch on this pilot, proposed pilot program for the essential package of health services. Can you speak for now? Okay. So first of all, the essential package of services, we are only implementing four of the services, possibly that will be in the essential packages of services. And those would be for diabetes and hypertension. So those services are screening for diabetes, treatment for diabetes, screening for hypertension, treatment for hypertension. So what we will do is set goals for both the screening and the treatment based on the number of people in each of the communities that we select. And then provide incentives or the incentives that I mentioned earlier for persons, for clients that we find who are diabetic or hypertensive, but also for the persons providing the services. Now as a pilot, eventually we will want to cover every single primary care facility or primary care region in the country. But at the design of this pilot, there were four regions which were selected. So they have centers in four regions. That's region three, region four, region six and region seven. So for some reason we saw that the north and the south regions were not included at this stage. But as I mentioned, they will be included when we start to implement and start to analyze the results and based on the level of preparedness and all of those other issues that we have to take into consideration before we include any facility into the screen. Okay, but what has the feedback been like so far? Very good, very good. I would say normally in the primary care setting the community we have full buying I would say from the community nursing. We also have full buying from the health management information system. And I think I kind of forgot to mention the planning unit earlier among some of the key stakeholders. The planning unit is a key stakeholder because they had been responsible for the full design and so far during the time that I've been here I've had full support from these departments as well as the epidemiology department within the Ministry of Health because it would require significant coordination and buying from these departments for us to get this program to be running smoothly in the country. Wonderful. You mentioned the benefits it has for the health, the providers and also the clients. But what is it that this unit is actually expecting to achieve with the performance base financing? Okay, so first of all we would after we have implemented let's say about two to three years we would expect to see a reduction in mortality. We would not want to see so many people dying from just diabetes or hypertension or even complications of diabetes and hypertension. So that's the first thing we would want to see. We would also want to see a reduction in the complications of diabetes and hypertension particularly with respect to foot care and then with respect to the dialysis and some of the more complicated things about diabetes and hypertension. We want to see a lot more evidence base programming and evidence base functioning so that we use data and that's one of the key things of the performance base financing because the performance is based on data and so currently we are implementing all of what we have to do to try to get that data so that we could start implementation of this a little later down in the year. But it's taking us some time because we have to put in place first of all put in place all of the different measures that we need to collect that data and to use the health management information system to analyze and produce that data on a regular basis. Okay, great. And quickly if you could just what final message would you like to leave with St. Lucian as it relates to the performance base financing? I would like to leave with St. Lucian the fact that lifestyles, our lifestyles contribute a lot to our health. I would like St. Lucian to be more appreciative of yes we need very good hospital care but what we need more is to try to adopt those behaviors so that we don't end up, too many of us end up in hospital where we have a lot more, the treatment is a lot more complex and a lot more expensive. In other words the message that I want to leave my final message is that embrace prevention so that we can have better health care. Thank you so much. Well that's how we come to the end of our program for today. I want to thank you so much for being part of this program and providing us with this information. Thank you very much for having my pleasure. On behalf of the entire production team I am Fenel Neptune. Thanks for watching. Until next time.