Saint Lucia, spanning 617 square kilometers (238 square miles) and home to 187,000 citizens, grapples with chronic non-communicable diseases – including diabetes and hypertension – which, according to the World Health Organization, are the leading causes of death on the island. Addressing this pressing issue, the Ministry of Health, Wellness, and Elderly Affairs, with financing from the World Bank under the Saint Lucia Health System Strengthening Project, has introduced a Performance-Based Financing Pilot Program.
“Having our clients know their status, what complications they have [and] what their risks are is going to help us reduce prevalence, and that is our major goal,” shared Yasmin Gabriel, Public Health Nursing Supervisor at the Anse Le Raye Health and Wellness Centre. She continued: “This would be persons who have never been diagnosed.... but may have a familial risk factor, maybe an issue with just maintaining normal blood pressures, things like that.”
Performance-Based Financing was initially implemented in eight wellness centers across the island. The second phase of the program, which includes the remaining nine centres, began on February 1, 2024. The initiative is expected to improve access to quality health services for hypertension and diabetes at the primary health care level. Further and uniquely, it aims to reward health centres for providing prevention and treatment services to patients.
“What the Performance-Based Financing is doing, it separates the catchment population, into two segments: those who have the disease and those who do not have the disease. It specifically defines services for screening for persons who do not have the disease, and then treatment services for persons who have the disease. You're going to have a comprehensive program that looks at the entire population as a unit, and not just those who are sick” added Nahum Jn. Baptiste, Performance-Based Financing Coordinator, Saint Lucia.
The health ministry, in seeking to revamp its approach, is aiming for greater client engagement in their care. Consequently, clients will play a more active role in shaping their healthcare experience with the 17 communities, representing both current residents and those aspiring to live in these areas.
The importance of strategic investments to enhance the resilience of health systems is widely known. These investments play a crucial role in safeguarding the well-being of the population, reinforcing the fundamental structures of health systems, and supporting frontline health workers. By doing so, countries gain the flexibility to not only address emerging pandemics but also to respond effectively to various shocks, whether they are of natural or human origin.
The dividends from such investments go beyond immediate health advantages. A more resilient health system serves as the cornerstone for robust and resilient economies, offering significant economic and societal advantages. This resilience helps avoid the necessity for stringent and expensive containment measures in future crises, fostering healthier and better-prepared societies.
“We do nutritional demonstrations, and we get to teach our clients who have diabetes and high blood pressure how to prepare their meals healthily. Alternative ways, exciting ways; sometimes just telling a client what to do is not as effective as showing them what to do. Clients often have to contend with whether or not they pay [for] their medication, get their lab test done, pay their rent, food, and bills. We know that the less persons we have ill, our disease burden on our economy reduces,” said Nurse Gabriel.
She added: “The personal economy is not affected as much because [clients] don't have to go spending money on medications. People are not calling [out] sick from work, so we know that our productivity is improved. We see people with better morale. We see weight reduction, [which] can directly translate into physical well-being. We are looking to see how all these activities can change every facet of the client - from physically, mentally, emotionally - this particular program is going to adjust that.”
Under the Performance-based Financing Program, health and wellness centers receive budgetary allocations to enhance facilities and the quality of care. These funds are allocated based on key performance indicators, promoting not only service provision but also the collection of data to demonstrate the attainment of predefined targets.
The introduction of the Performance-Based Financing Pilot Program in Saint Lucia marks a significant stride in the ongoing battle against chronic non-communicable diseases. As it continues to be implemented in wellness centers on the island, the initiative not only addresses prevalent health issues but also pioneers a client-centric approach, empowering individuals to actively shape their healthcare experiences.
The program's emphasis on data-driven performance indicators not only improves service provision but also aligns with the broader goals of a resilient health system, and further advances Saint Lucia on its Universal Health Coverage journey.