Health Reform in a small resource limited country: The Limits of the Input-Output Model and The Way Forward

Abstract

Introduction: Recurrent health problems have led to multiple health enquiries/commissions and interventions to address these issues and meet expectations. This study explored healthcare reform and future steps to achieve success. 

Methods: Data obtained from medical records of the Ministry of Health (MOH), Pan American Health Organization (PAHO) websites, and numerous search engines were reviewed. Epidemiological and statistical data were analyzed to identify relevant variables and to determine differences between expected/or that obtained from developed countries and those obtained from the health reform measures.   

Results: Inequity, inefficiency, patient dissatisfaction, poor throughput processes and overcrowding were prevalent.  National clinical indicators such as [a relatively high] infant mortality rate (IMR), maternal mortality rate (MMR), neonatal mortality rate (NMR), under-5 mortality rate, and [a relatively low] life expectancy (LE), were suboptimal.  The decades of inadequate quality health care led to a multitude of enquiries, most notably the West India Royal (Moyne) Commission (1938-1939), and the Gladys Gafoor Commission (2007), and many health reform “input” interventions (structural, services, financial and management) such as decentralization (1994) and the Health Sector Reform Program (HSRP) in 1994. Acceptable outputs by increasing inputs (input-output model) were not evident. There was much less emphasis on processes, outcomes, and support tools. 

Conclusion: Health reform measures using the “input-output model” did not bring about the desired quality health care. The way forward must include optimizing throughput processes, outcome-oriented strategies, and the use of Continuous Quality Improvement, monitoring, prioritization, capacity building, research and use of evidence-based guidelines and decision-making tools.    

Keywords: health outcomes, health reform, healthcare, innovation, input-output model, reorienting health services, Trinidad and Tobago.