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Implementation of National Health Insurance in Grenada


Statement by the Inter Agency Group of Development Organisations (IAGDO)/Grouping of Civil Society Organisations (CSOs) on meeting with the Joint Independent Provider Association (JIPA) Consultants.

 On 14 January 2020, the Inter Agency Group of Development Organisations, in collaboration with the Grouping of Civil Society Organisations, met with Dr Kester Nedd and other representatives of the Joint Independent Provider Association (JIPA), to receive their proposals for the implementation of a National Health Insurance (NHI) in Grenada. Dr Nedd had requested a meeting with the IAGDO and Civil Society Organisations to:

  • Share the JIPA/NHI recommendations;
  • Obtain comments and any pitfalls that may be found with the process and the programme.

Background:

JIPA held a national consultation with stakeholders on 18-19 November 2019. The Hon. Prime Minister and Minister for Finance, in delivering the 2020 Budget Speech on 20 November 2019, announced that government had contracted the Miami based firm, to complete the process of development for implementation of the National Health Insurance Programme. The project according to the Prime Minister was valued at $1.5 million.

Via the 2020 Budget Speech, the nation was advised of the following:

  • Achieving Universal Health Coverage: In 2019 the Ministry of Health continued work on health financing initiatives aimed at achieving a system of universal health coverage, as outlined in the Sustainable Development Goals (SDGs);
  • Phase 1 Deliverables Completed: Deliverables for the first phase of the National Health Insurance Project had been completed.
  • Phase 2: The second phase, to develop the implementation plan to institutionalise such coverage, was expected to commence before the end of the year.

To facilitate preparation for the meeting, Dr Nedd was requested to make available his draft proposal/recommendations on National Health Insurance. This document was circulated to all invitees and is available to the public courtesy the Grenada Broadcast website, https://www.grenadabroadcaStcom/wpcontent/uploads/2020/01/December-2019-IPAs-suggested-model-for-NHI.pdf

Twenty-two persons attended the meeting, including representatives of member agencies of the Inter Agency Group of Development Organisations, the Grouping of Civil Society Organisations and a number of special invitees, considered persons with experience and knowledge of Grenada’s health sector.

The meeting featured:

  • A presentation from Dr Nedd of JIPA on The Suggested Model for National Health Insurance in Grenada;
  • Initial reaction/feedback from four specially selected discussants who were requested to focus on specific perspectives re JIPA’s recommendations:
    • Curlan Gilchrist – Economist/former Director of Statistics and currently a lecturer at St George’s University;
    • Kennedy Roberts – Health Economist and currently a lecturer at St George’s University;
    • Joyce Thomas – Consultant who works with health facilities and hospitals throughout the Caricom region;
    • Gemma Bain-Thomas – Consultant and former Cabinet Secretary; a former Permanent Secretary in the Ministry of Health.
  • Plenary discussion.

JIPA Recommendations for National Health Insurance:

The document dated 9 December 2019 – Suggested Model NHI for Grenada – circulated by JIPA, provided details on the suggested model for National Health Insurance[1] in Grenada. In his presentation, Dr Nedd outlined a three-tier model as follows:

  • Tier 1: Tier 1 is to be covered by the National Health Insurance/Government. In this proposal all citizens will be covered up to a maximum amount that is To Be Determined.
    • Services: The services to be provided would include all primary health care services and some speciality care, non-specialised pediatric services, certain laboratory and diagnostic services, emergency room care and obstetrics care, the scope of which had not been outlined.
    • Payment: Payment for these services would be through the NHI/Government imposing a 1% – 2% levy on goods and services and the utilisation of a portion of the current budgetary allocation for the health services which would be administered by JIPA.
  • Tier 2: Tier 2 would start at a dollar amount above Tier 1.
    • Services: It would cover secondary specialist procedures and care yet to be determined.
    • Payment: It would be funded by insurance and self-funded employer programmes.
  • Tier 3: Tier 3 will be for an amount above Tier 2 and up to an amount to be determined.
    • Services: It would cater for care at the catastrophic level.
    • Payment: It would be paid for via being insured by an insurance company, employer or reinsurance company.

Queries/Observations/Comments re the JIPA Recommendations:

The following observations were noted:

  • NHI Model/Design: While the 2020 Budget Speech indicated that Grenada was at the implementation stage, having completed the phase 1 deliverables, the model or design of the NHI for Grenada is still not known.
  • Prior Studies by UWI – Health Economics Unit: It appeared that those in authority or with responsibility have reverted to the development stage as it relates to the preparation for implementation of the NHI in Grenada. It is necessary to remind both the Government and JIPA that the Health Economics Unit of the UWI was contracted and did a significant amount of work on NHI.
  • Meeting the Needs of Grenadians: Is the proposed JIPA model meeting the needs of all Grenadians? To ensure clarity, information is required on the following:
  • Phase 1 Deliverables: What were the Phase 1 deliverables referred to in the 2020 Budget Speech;
    • UWI Report and Recommendations: Where is the report and recommendations from the UWI-Health Economics Unit team? When will it be made public or available to stakeholders?
    • Grenada Policy on National Health Insurance: What is the stated policy of the government on the implementation of NHI?
    • NHI Secretariat: What is the current status of the NHI Secretariat?
    • Terms of Reference of JIPA: What are the Terms of Reference of JIPA?
    • JIPA Proposal and National Health Insurance: Is the JIPA Proposal consistent with the mandate for universal health coverage? Who is responsible for reviewing JIPA’s proposal on behalf of the Government of Grenada?
  • NHI – a Financing Option: National Health Insurance is not a panacea for the issues facing Grenada’s health care system. It is a financing option to ensure access to health care regardless of ability to pay or purchase services.
  • Burden of Levy/VAT: A levy of 1% – 2% on goods and services to pay for Tier 1 health services will be more burdensome for the lower income and in that respect a proper, detailed and dynamic financial analysis is required.
  • Preparation for the Implementation of NHI: There is significant work to be completed in preparation for the implementation of the NHI. This includes strengthening of health systems; establishment of NHI Fund and key supporting institutions; the financing plan; management and governance structures; the relevant legislation; contracting of services; registration of the population or the participants in the NHI; introduction and operation of the fund.
  • Transparency and Public Participation: There is a need for greater transparency and public participation in the process.
  • Status of NHI: A clear statement is required from government on the status of the proposed National Health Insurance.
  • Right to Information: Information must be readily available to the general public; in a form that is easily understood and accessible to everyone.
  • Community Fora: There needs to be fora across the country and information in hard copy format available at these fora.

The IAGDO and Grouping of CSOs take this opportunity to thank JIPA for the invitation to meet and receive its proposals and reiterate their support to the implementation of an NHI in Grenada, and their commitment to work with the implementation team to ensure that the final product is one which meets the needs of Grenada.


[1] Available on Grenada Broadcast website:  https://www.grenadabroadcaStcom/wpcontent/uploads/2020/01/December-2019-IPAs-suggested-model-for-NHI.pdf

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