AN OVERVIEW

Discussions on health sector reform in Belize began in 1994 as an ongoing dialogue between the Government of Belize and the International Development Bank regarding the need to improve the health status of the population.  In 1996, the IDB approved a non-reimbursable technical cooperation financing for the preparation of studies for health sector reform. To this end, a firm (Cambridge Consulting Corporation and Resources Management Corporation) was contracted to conduct evaluation and analysis of the status of the health sector in Belize.  The primary goal was to identify and support the adoption of government policies and programs, which would promote improvements in the adequacy and allocation of health resources within the health sector so that quality health care would be made available in an efficient and effective way to all Belizeans.

These improvements, at a minimum, were to involve improved efficiency in health services delivery, an expansion and diversification of sources of financing for these services, health sector policy reform, development of the private sector, and steps to improve the organization and management of the health services provided by the public sector.  The firm completed its task in 1998 with the presentation of a final report (Belize Ministry of Health and Sports Health Policy Reform Project, project No. ATN/SF-4686-BL, Final Report) that highlights the full analysis of the different elements, and some proposed solutions presented in the form of options.  Subsequently, a new firm was employed (Health and Life Sciences Partnership) to conduct the feasibility study and further develop the options presented.  This was to be the basis for a formal proposal submitted to the IDB for a health sector investment loan.

In the first report submitted by the Cambridge Consulting Corporation, significant work was done in the area of health sector financing, among other areas.  This report proposed three basic options for consideration: a pure cost-sharing approach with user fees; a social insurance model designed to provide public and private sector coverage to those with formal employment, together with their families; and a new mixed-model, which combines cost-sharing with social insurance.  In the process of developing the options further, the consultants for the Health and Life Sciences Partnership proposed the establishment of a "National Health Insurance Agency as the prime funder and purchaser of personal health care services - public and private…The NHIA will be established as an independent statutory authority or as part of the existing Social Security Board but maintaining separate financial arrangements."

The final project submission from the Government of Belize to the IDB describes three major components:

1. Organizational Restructuring: This component focuses on the deconcentration of operational authority to regional management teams as well as the piloting of Autonomy for the Karl Heusner Memorial Hospital.  The central Ministry of Health defines its new role in terms of overall monitoring and regulation.

2. Services Rationalization and improvement: Focuses on upgrading the infrastructure of the public service (Ministry of Health).  A reconfiguration exercise defines three regional hospitals (Orange Walk, Belmopan and Dangriga) providing the four basic secondary services - general medicine, Pediatrics, general surgery, and Obstetrics and Gynecology.  The other district hospitals will be converted into polyclinics (community hospitals) which provide primary level care.  KHMH then becomes the national referral hospital offering more specialized care.

3. Financing: Deals with the establishment of a National Health Insurance Agency as the prime funding source and purchaser of personal health care services, both public and private.
   
   One of the clear decisions made by Cabinet was the establishment of National Health Insurance under the Social Security Board Belize.  The justification being that, for a small economy like Belize it would be illogical to establish a whole new organization to run NHI.   In order to deal with the issue of transparency and accountability of the funds to be administered under BSSB-NHI, a draft Bill for an Act to amend the Social Security Act submitted for approval by cabinet after significant consultation had been carried out with important stakeholders.
   
   A pilot project was implemented in the Belize District South Side, officially launched on the 9th of August 2001.  It officially ended on the 12th of February, 2002, when a detailed report was produced.  Overall, it was considered extremely successful.  The results were later validated by a team of consultants from Cambridge Consulting Company, contracted through Multilateral Investment Fund (M.I.F.)
   
   There have been subsequent extensions to the project on the South Side. Some modifications have been made in the contracting process to drive efficiency and productivity while at the same time ensuring quality.
   
   Cabinet made a decision to roll-out the NHI scheme to the South of the Country.  On June 5th, 2006 contracts were officially signed with Public Sector  Primary Care Providers in the South of the country.  It is expected that this will signal the period of transformation in the health care delivery of the Stann Creek and Toledo districts, moving towards quality and efficient health care.