SECTOR: Health

PROJECT NAME: Health Sector Modernization and Restructuring

(1047/OC-DR)

TOTAL COST: $75 million

FINANCING:

IDB $61.2 million

OTHER $5.0 million (Organization of Petroleum Exporting Countries-OPEC)

OTHER $3.5 million (Nordic Development Fund-NDF)

LOCAL $5.3 million

DATE OF APPROVAL: October 8, 1997

GENERAL DESCRIPTION: The objective of the program is to improve the health status of low and middle-income populations by supporting the Government's strategy to improve the efficiency, equity and quality of the health system through implementing policy, institutional and service delivery reforms.

The program will finance the following components: (a) policy development; (b) institutional reorganization of the Health Ministry (SESPAS); (c) restructuring and institutional modernization of the social insurance-financed health system; and (d) strengthening of basic and hospital services. The second component consists of three subcomponents: (a) SESPAS reorganization; (b) financial management reorganization and strengthening; and (c) modernization of procurement, inventory and distribution of drugs and medical supplies. The third subcomponent involves two subcomponents: (a) institutional strengthening and studies; and (b) implementation of the new social insurance-financed health system. The last component implements the following subcomponents: (a) Primary Care Fund (FONAP); (b) Solidarity Fund (FONSOL); and (c) Fund for Hospital Management and Upgrading (FONHOSPITAL). The last subcomponent consists of two activities: (a) management reforms; and (b) rehabilitation and equipment.

CONSULTANTS: Consultants will be hired to undertake the following activities under the first component: (a) define and approve policies as well as develop the supporting legal and regulatory framework, including a National Health Law and Social Security Health Law; (b) enhance quality by establishing processes, adopting standards, and developing the corresponding regulatory framework for handling of hazardous hospital waste and the accreditation of health care providers, insurers and medical supply producers; (c) garner support for health reform and modernization initiatives through design and implementation of strategies of dissemination, promotion and formation of strategic alliances.

Under the second component, consultants will be hired to undertake the following activities: (a) provide support for the design, testing and implementation of a demand-driven system for the procurement and distribution of drugs and medical supplies; (b) introduce quality control standards; (c) inventory and redefine positions and personnel profiles; (d) revamp tax recollection, enrolle registration, billing and audit systems; (e) redefine the structure, procedures and management of the budgetary process; (f) define mission and organizational structure of the Dominican Social Security Institute (IDSS); (g) design a personnel payment system that rewards performance; (h) define norms and procedures for contracting private providers and insurers; (i) develop a plan for gradual coverage extension and guide the transition from the current to the new system; (j) design and establish the institutional framework and corresponding governance, managerial and organizational structures related to major system functions, including planning and system oversight, supervision, regulation and accreditation, collection and allocation of funds, contracting and negotiation, subscriber enrollment, and information collection, analysis and dissemination; (k) develop system standards, rules and procedures for the above functions; (l) define and cost a benchmark service plan; (m) strengthen the capacity of public and private delivery networks to assume risks, organize networks, contract physicians and other providers, manage utilization, track and contain costs, collect and analyze information, monitor quality and patient satisfaction, manage human resources and evaluate results; and (m) extend coverage through implementing pilots linking social insurance financing to private and public networks.

Other activities to be carried out by consultants will be the preparation of operational manuals

GOODS AND EQUIPMENT: The following goods will be procured: computer equipment, software, modems, printers, telephone lines, cabling, drugs and supplies.

CIVIL WORKS: The program will finance the following civil works: (a) rehabilitation of four hospitals; and (b) rehabilitation of infrastructure and the installation of equipment and systems for the "self-contained" treatment of liquid and solid wastes.

EXECUTING AGENCY: Comisión Ejecutiva de La Reforma del Sector Salud

Unidad Coordinadorade Proyecto

Secretaria Técnica de la Presidencia

Gustavo Mejía Ricart 141, tercer piso

Edificio Montalvo & Sucursal

Santo Domingo, República Dominicana

Tel: (809) 547-2509

Fax: (809) 565-2768

Contact: Dr. Alberto Fiallo

Coordinador Ejecutivo, CERSS