The following was prepared by the Transition Team of the Anguilla Health Authority:

Background Information

1. Why do we need a Health Authority?
A Health Authority is required to provide an opportunity for making better use of scare resources and general improvement to the quality of services. Moreover, it will address problems of administrative inefficiencies in the health system.

2. Why is there the need to improve health services?
There are essentially 3 reasons:
* To make more efficient use of resources
* To increase health services autonomy and giving managers clear responsibility for performance
* To introduce measures to make more efficient use of scarce resources
3. Why is there a need to focus on making health services more efficient?
* To correct the imbalance between available resources (especially finance) and the demand for them;
* To shift resources towards preventative programmes in (primary health care);
* To increase patient throughput and reduce in-patient stay at hospitals;
* To improve the quality and quantity of services delivery for the same or less expenditure.
4. What is the strategy adopted for reviewing the provision of health services?
* Affordability – how much funding will be available and how much efficient good quality care this will support?
* Needs/demand for services – what is the structure of the population and how does the geographical distribution of the population affect access to care and levels of utilisation?
* The political environment – would a government be willing to take difficult decisions on closing health facilities or wards?
5. What steps should be considered in developing a health services strategy?
* Project the workload to be generated by the population. This will be utilised to project staffing, drugs and supplies levels by clinical departments;
* Analyse how much it will cost to run the health services at an acceptable level of quality and operational efficiency;
* Look at affordability: what financing is likely to be available to run the health services? Past trends in funding will provide a guide but this will need to be adjusted based on future policies affecting funding, user fees, economic trends;
6. What is meant by increased autonomy?
* Autonomy is the delegation of management authority and responsibility away from the Ministry of Health to local management and (the Anguilla Health Authority). In the case of health services, typically it involves:
* Management powers vested in a Board which is responsible to managing the health services;
* Levels of funding and the services to be delivered are set out in an annual services agreement; and
* The composition of the Board is designed to reflect local ownership and accountability; hence the reason why members are selected with particular skills and relevant managerial expertise.
7. What are the benefits of increased management autonomy?
There are several benefits that include:
* Improved decision-making as better information is available locally;
* Faster decision-making;
* Greater accountability as the Board can monitor usage of funds and service level improvements;
* There is a clear definition of what services are to be expected;
* It will be easier to review fees or other financing arrangements without unnecessary delays;
* Increased morale and motivation as staff can address issues without being constrained by bureaucracy.
8. What areas of responsibility are usually delegated?
The shift in management responsibility usually takes place in 3 main areas:
* Financial management – managers can now decide on how best to spend the resources available given the particular needs of the health services;
* Personnel delegation – managers have greater scope to motivate staff, reward good performance and deal with poor performers;
* Service development planning – managers can decide how best to develop their services within the parameters of policies of the Health Authority.
9. What is the difference between statutorisation (Health Authority) and privitisation?
Privatisation is generally profit-based while statutorisation is service-based.
Privatisation means the transfer of ownership of public assets into private hands, usually by sale to a profit making private enterprise.
However management autonomy involves establishing the health services as legal entity (AHA) in the public rather than a profit-making venture. This is so because government will remain the major contributor to health services (in the medium term) in order to ensure equity and access for the population. This ensures that health expenditures and costs are contained within affordable levels.

Governance

10. What is the organisational relationship between the Ministry of Health and AHA?
The Ministry of Health will:
* focus on national policy formulation, regulations, setting standards, monitoring and enforcement;
* ensure that a national strategic plan is developed;
* ensure the enforcement of the Environmental Health Act;
* ‘purchase’ services from the Health Authority.

The Anguilla Health Authority:
* is a corporate body which will be responsible for all operational matters that promote and protect the health of persons;
* will also:
* provide integrated health services;
* operate, maintain, equip and extend facilities;
* ensure reasonable access to quality health services is provided to the public;
* routinely assess the needs for ‘personal care’ of persons
11. What will happen to the function of Environmental Health?
The Ministry of Health will manage the functions of the Environmental Health and Water Laboratory.

To be continued ...

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