STRATEGIC PLAN TO FURTHER THE HEALTH SECTOR FINANCING REFORM IN TAJIKISTAN

Transcription

1 STRATEGIC PLAN TO FURTHER THE HEALTH SECTOR FINANCING REFORM IN TAJIKISTAN Action Actor Result I. New Payment Mechanisms in the Primary Health Care (PHC) Facilities 1.1 Introduction of Per Capita Financing in the PHC facilities Analyze and evaluate the implementation of the per capita financing in the PHC facilities at the national level Develop a methodology for the budget formation, payment to PHC providers based on the analysis and evaluation of the implemented per capita financing system Revise, improve and adopt a methodology and per capita financing model for the PHC facilities Develop and adopt a unified rate and a mechanism of equalizing the PHC financing across cities and districts at the level of province Ministry of Health and Social Protection (MH&SP), Ministry of Finance (MOF), World Health Organization (WHO), USAID, project of USAID Analytical report based on the evaluation results is presented The methodology developed The methodology and model are developed and approved The equalizing mechanism for financing is developed and approved

2 1.1.5 Prepare the 2016 budget for the PHC facilities in Sugd based on the unified per capita norm Prepare the pilot implementation of the per capita financing in the PHC facilities of GBAO, Khatlon province and centrallyadministered districts (CAD) Prepare the 2017 PHC budget for GBAO, Khatlon and CAD based on the unified per capita norm Transit the Sugd PHC facilities to per capita financing Monitor and evaluate (M & E) the implementation of the per capita financing in Sugd PHC facilities Single per capita rate is developed and approved, the budget of Sugd region's PHC is formed based on the unified per capita norm The preparatory work is carried out to introduce per capita financing in PHC of GBAO, Khatlon and CAD Sugd PHC facilities are fully financed based on the per capita mechanism M & E Report

3 Develop and adopt a unified rate and mechanism of equalizing the PHC financing across cities and districts at the national level Prepare the 2018 PHC budget based a unified per capita norm Transit the country's PHC facilities to per capita financing M & E the implementation of the per capita financing in PHC facilities Integrate per capita financing into Mandatory Health Insurance system (MHI) The equalizing mechanism for financing is developed and approved The unified per capita norm is developed and approved, the budget of the whole country's PHC is formed based on the unified per capita norm All PHC facilities of the country are financed based on the per capita mechanism M & E Report PHC facilities are financed based on per capita mechanism under the MHI

4 1.2.1 Develop and approve a methodology to implement the "Performance-based Financing" in the PHC facilities Develop and approve a mechanism to monitor (control) the quality of services at the PHC level Implement on a pilot basis the "Performance-based Financing" in PHC facilities of Spitamen district of Sugd province (pay the bonus-for-performance to health workers based on their indicators) M & E the implementation of the ""Performance-based Financing" in Spitamen district of Sugd province Prepare the implementation of the "Performance-based Financing" in the PHC facilities of the following districts: J. Rasulov, Ghonchi, Mastcha of Sugd province and districts of Farkhor, Rumi, Yavan and Kabadiyan of Khatlon province Expand the "Performancebased Financing" project in the PHC facilities of J. Rasulov Ghonchi, Mastcha of Sugd province and districts of 1.2. Performance-based Financing of the PHC Facilities WB, WB WB. WB WB WB The methodology is developed and approved Decree on the approval of a quality control mechanism PHC facilities of Spitamen district receive additional funding based on their performance M & E report Preparatory works are carried out in the PHC facilities in the following districts: J. Rasulov, Ghonchi, Mastcha of Sugd province and districts of Farkhor, Rumi, Yavan and Kabadiyan of Khatlon province The PHC facilities of such districts as J. Rasulov Ghonchi, Mastcha of Sugd province and districts of Farkhor, Rumi, Yavan and

5 Farkhor, Rumi, Yavan and Kabadiyan of Khatlon province M & E the implementation of the "Performance-based Financing" in the PHC facilities of J. Rasulov, Ghonchi, Mastcha districts of Sugd province and districts of Farkhor, Rumi, Yavan and Kabadiyan of Khatlon province Prepare the implementation of "Performance-based Financing" in the PHC facilities at the national level Develop and approve the quality control mechanism at the PHC level. Adjust the formula based on the findings and recommendations Expand the "Performancebased Financing" project in other PHC facilities based on the results of piloting at the national level WB WB WB WB. Kabadiyan of Khatlon province receive additional funding based on their performance M & E Report Other PHC facilities receive additional funding based on their performance Analyze and evaluate the current status of the hospital financing system and develop proposals to introduce the case-based payment mechanism II. New Payment Mechanisms and Restructuring of Hospitals 2.1 Introduction of Case-based Hospital Payment System Analysis report

6 2.1.2 Develop and approve a methodology for the casebased hospital payment mechanism Strengthen the information system (ф-066) in hospitals Prepare the pilot implementation of the casebased payment mechanism in Sugd hospitals Revise the role of the Division to Introduce New Financing Mechanisms of the Sugd Province Health Department in line with the health financing reform and jointly with the Sugd Province Finance Department, create a mechanism to monitor the quality of financial data Develop and adopt a unified payment rate for Sugd province Prepare the list of hospitals to be transferred to the new financing method in Sugd region USAID, USAID, USAID, USAID, The methodology developed and approved Routine collection of ф-066 data for all hospitals is established Preparatory work done Decree on the establishment of the single payer structure The unified payment rate developed and approved The list of hospitals to be transferred to the new financing method in Sugd region is approved

7 2.1.8 Prepare and adopt the 2016 budget for Sugd hospitals transiting to new financing mechanism based on the approved unified payment rate per case Organize the work to enter, transmit and process data in line with the form 66 to further finance hospitals in Sugd Develop and adopt indicators to monitor and evaluate the implementation of the new case-based payment system Transit Sugd hospitals to the case-based payment mechanism M & E the implementation of the case-based hospital payment system in Sugd Prepare to expand the casebased hospital payment mechanism to other regions The budget of hospitals are formed based on unified payment rate and approved The work to enter, transmit and process the data in line with the form 66 is organized Decree on the approval of M & E indicators Sugd hospitals are financed through the case-based payment M & E report Preparatory activities carried out

8 Transit all hospitals to the cased-based payment mechanism Integrate the case-based payment mechanism into the MHI system Analyze, evaluate and revise Strategic Plan for Streamlining Health Institutions in Tajikistan during Study the experience of the German on restructuring and streamlining hospital services Collect and analyze data on hospital performance to find the optimal structure of hospitals Develop and approve the methodology and plan for hospitals restructuring Restructure hospitals German Development Bank 2.2 Restructuring of Hospitals All hospitals are financed through the case-based payment system The hospitals are financed through the case-based payment system under the MHI Report The structure of the hospitals is defined Decree on the approval of the methodology and plan The hospital are restructured

9 3.1 Establish an expert group to introduce the MHI 3.2 Analyze the Health Insurance Law and suggest improvements 3.3 Make proposals to amend existing legislation 3.4 Develop a mechanism to collect and accumulate health resources, including insurance contributions in the form of a tax on salaries 3.5 Determination of the structure to collect the social insurance tax 3.6 Develop an interaction model between the Mandatory Health Insurance Fund and service providers III. Financing System and Financial Flows, Creation of the Mandatory Health Insurance Fund Ministry of Labour, Employment & Migration (MLEM), Ministry of Economic Development & Trade (MEDT), Tax Committee, Agency for Social Insurance & Pensions, USAID. Decree on the establishment of the expert group Analysis report Proposals are developed and disseminated The mechanism is designed The structure is developed The mechanism is designed

10 3.7 Develop a methodology to assess the quality of services provided by suppliers 3.8 Prepare and approve the MHI's legal framework 3.9 Develop and approve the financial reporting and registration forms 3.10 Create Mandatory Health Insurance Fund and its branches 3.11 Transfer the 2017 budget resources and the MHI tax funds to the Mandatory Health Insurance Fund 3.12 Improve and implement the MHI 3.13 Work with local communities on the MHI Mandatory Health Insurance Fund (MHIF) MHIF of Swiss Cooperation Office The methodology is approved The MHI's legal framework is approved The financial reporting and registration forms are approved Decree on the creation Government Resolution 4.1 Analyze the possibility to expand the BBP 4.2 Revise the BBP in and prepare the price list for the BBP services 4.3 Expand the BBP in such districts as Shugnon of GBAO province; Hamadoni and Panj IV. Government-guaranteed Basic Benefits Package (BBP) WHO WHO Report is prepared Government Resolution 20 dated March 1, 2014 supported by the joint Decree of January 31, 2014, MOF and MEDT in coordination with the Antimonopoly Service Government Resolution 20 of January 3, 2014

11 of Khatlon province; Asht and Istaravshan of Sugd province; and Faizabad of CAD 4.4 Monitor and evaluate the BBP implementation in the pilot districts 4.5 Find out the BBP financing gap in the pilot districts 4.6 Revise the volume of improved BBP services under the basic and additional program 4.7 Revise the list of the BBP eligible group based on existing funds 4.8 Make proposals to improve the BBP based on the analysis and adaptation of the BBP as well as basic and additional MHI program Report Estimation results The volume of the BBP services is revised The list of the BBP eligible group is revised The BBP is adapted taking into consideration the base and additional program

12 4.9 Expand the BBP/basic program in Sugd 4.10 M & E the BBP in Sugd 4.11 Expand the BBP at the national level under the MHI 4.12 Integrate the BBP into MHI 4.13 Work with the community on the BBP of SwCO Government Resolution Report Government Resolution The BBP is integrated into the MHI

13 5.1 Organize meetings of the technical working groups 5.2 Study the experience of other countries (Armenia, Moldova, the Russian Federation) to implement new financing mechanisms and MHI 5.3 Organize roundtables on new financing mechanisms and MHI to present the M & E results, analysis of undertaken interventions/reforms 5.4 Participate in the seminars on the new financing mechanism and MHI V. Capacity Building Working Group members, German, German, German Minutes of the meetings Organization of study tours, decree Decree, minutes Decree, minutes