Please write a 300-450 word executive summary touching on each building block of the assignment attached. Basically our group assignment consists of 6 building blocks which are provided. You will only need to write the summary on 5 out of the 6 building blocks as 'Health Service Delivery' has not been done by one of the students as they have dropped out of the course.
Cook Islands health system is currently challenged to respond to the NCD epidemic, health workforce issues, disasters (natural and human induced), emerging infectious diseases and outbreaks, ageing population and rising communities’ expectation on health care services. In addition, the Cook Islands Government and Te Marae Ora are committed to tackling health inequalities through targeted health promotion and better access to health care for those in need.
Therefore, please add some information about health workforce issues...just to highlight the current issues facing Cook Islands. A quick summary about all the building blocks needs to be included in the executive summary.Many thanks.
Building Blocks included (2-7):
1.EXECUTIVE SUMMARY2.GOVERNANCE, STEWARDSHIP3HEALTH SERVICE DELIVERY (disclosed still numbered)4 HEALTH WORKFORCE5 HEALTH INFORMATION SYSTEM6 HEALTH FINANCING7MEDICINES, VACCINES AND TECHNOLOGY
1.
1. Executive Summary 2. GOVERNANCE, STEWARDSHIP Leadership and Governance: Cook Island · Cook Islands uses a national health care system. Health Care is governed by their Ministry of Health, Te Marae Ora (TMO). · The Ministry of Health is divided into 3 directorates: Community Health Services, Hospital Health Services, Funding and Planning. Introduction In 2007 the Government of Cook Islands National began their National Sustainable Development plan (NSDP) for 2007-2020. This plan listed goals and strategies framed for the islands’ present and future challenges in national sustainability. It also addressed the need for improving the accountability of the government and the interconnectedness with communities. The NSDP provided the framework to improve the government operated national healthcare system. Over the last 10 years Cook Islands government have made large efforts to improve on several aspects of their healthcare according to their goals listed in their NSDP. Cook Islands have taken on policy changes to ensure that essential medicines were extensively secured, opened nursing school to meet the demands of the workforce, The Te Marae Ora Ministry of Health (TMO), the government branch in charge of the national health care and water sanitation for Cook Islands, (CK IsD website) developed a 2012-2016 National Health Strategy. This strategy focused on current problems: amount of government spending, the need for larger health care workforce and for health information system, a platform and budget for public health surveillance, and research budget. From objectives of the National Health Strategy, the TMO gathered stakeholders, local organizations, religious groups, non-government organizations including WHO, created the Clinical Health Workforce Plan 2015-2020. This plan addressed the nation’s overall issues: the rise of non-communicable diseases on the islands, sustainable healthcare and workforce retention for the outer islands. Their workforce plan also proposed strategies to keep healthcare cost within the constraints of the country’s budget (ClN WFP 2015-2020). Rules-based/Outcome-based indicators for Measuring Health System Governance Determinants The Ministry of Health strategize with Ministry of Finance and Economic Management, the Ministry of Education to find more effective ways to extract information on the country. In the Household Expenditure Survey of 2005-2006, questions on education and health expenditure were added to the survey. The Ministries found opportunities to ascertain the broader needs the citizens through the questions in the country’s census. Future census now accounts for specific areas of social surveillance including: health of the household, labour and income, workforce, education, water quality. This opportunity in the led to better constructed questions, sampling methods, data gathering and information management in later census surveillance (Cook Island Population Census 2006). These changes guided Cook Islands government towards effective goals, indicators and strategies to drive decisions that help establish laws and policies. Furthermore, these changes drove the need for the fluidity of the questions in future census surveying as needs change over time. · Dissemination of this data gave insight for the need for several different databases to track the workforce entry/exit, facilities management, labour productivity and earnings, Database management???? · The frequency of the census is often enough to have a good picture of the Health/workforce of the Country and idea of Country’s budget??? · All of which lead to the goals set for the Country and the strategies need to obtain those goals and indicators by which to measure those goals for further improvement. Core Indicators Recently, in 2015-16 the Ministry of Finance for Cook Islands conducted the second Household Income Expenditure Survey in the planning of the Clinical Health Workforce Plan 2015-2020. Recommendations: · Stability in the Country’s budget for surveillance and data management 3 *HEALTH SERVICE DELIVERY (disclosed still numbered) * 4 HEALTH WORKFORCE Health Workforce of Cook Islands Shortages Cook Islands’ development is challenged by its narrow economic base, limited natural resources, fragile environment, shortage of skilled labour and relatively remote location (DFAT, 2019). The shortage of skilled workforce is due to either the internal or international migration pattern (emigration and immigration) of health workforce. Emigration of Pacific Island SHWs (Skilled Health Workforces) occurs at all occupational levels, and especially among those with postgraduate and specialist qualifications (Doyle & Roberts, 2013). Cook Islands is one of the Pacific Islands countries which experienced a loss of health workforces. They are enhanced to leave Cook Islands and migrate to NZ (New Zealand) easily because of the strong cultural tradition to move to NZ and also as a result of dual citizenship. It has been reported recently that the migration of SHWs from the selected PICs (Pacific Island Countries) is not well documented and that there are currently no formal processes in place specifically designed to collect migration and mobility data (Doyle et al. 2012). In Cook Islands, the availability of migration data is partially recorded (see appendix …). Information and procedures regarding training overseas (pre-service, post-basic or postgraduate) for individuals, health practitioners, and other health workers are gained through the Human Resource Division, The Ministry of Health of Cook Islands, while there is no data for national emigration policy. Internal migration, including the movement of SHWs from rural to urban centres, has been described as ‘ubiquitous’ throughout countries within the Asia Pacific region [Connell 2010 p. 15]. The rural and remote areas are the critical challenge to affect the health systems being firmly performed. The health workforces are facing working difficulties, feeling being isolated and uncomfortable living conditions. That factors hamper the retention of staff in outlying areas. Another form of internal migration is the movement of SHWs from the public to private sector. The Cook Islands has a pool of private health practitioners consisting of 3 medical practitioners, 1 dentist and 1 pharmacist [Cook Islands MoH n.d.b]), flows of health workers to the private sector have been in evidence. Gallina in 2010 mentioned that the Human Mobility Report also notes that education and training often became the reason of migrating health workforces, with sizable flows from a number of PICs (Pacific Island Countries) including Cook Islands, Samoa, Solomon Islands and Vanuatu to the University of the South Pacific. Distribution? Compared to the Western Pacific region with 14.5 doctors per 10,000 population, Cook Islands is considered a country with a low density of health workforces which only had 12 doctors per 10,000 population over 2000 to 2010. Highly dispersed population becomes the challenge for the distribution of the health workforces. Rarotonga is the island with the densest population where majority of the health workforce is concentrated (78%). In the same time, Aitukaki with only 9% of the total workforce is maintaining a small workforce together with other islands focusing on health protection and dental services. A small pool of medical officers are allocated in the outer islands to lead health services (nurse practitioners and registered nurses). Disparities between the Main Island and outer islands in relation to access to healthcare reflect differences in the health workforce. During recent years, the Ministry of Health has concentrated on providing sufficient general practitioners to provide health services in the outer islands. Whilst four islands (Pukapuka, Penrhyn, Mitioro and Rakahanga) have health officers they do not have a resident doctor. As of September 2012, Cook Islands has approximately 294 medical staff distributed throughout the population. Nurses, much like many other Pacific nations, are the largest workforce within the Cook Islands. There are currently 64 nurses at Rarotonga hospital, comprising of six charge nurses, 48 registered nurses, two enrolled nurses and eight nurse-aid positions. There are 36 nurses on the outer islands, which includes five nurse practitioners. Monitoring of hw? Registered health professional Medical and Dental Council (Medical and Dental Practitioners), Nursing Council (Registered Nurses, Community Nurses, Nurse Aides, Midwives, Nurse trainee). Allied health professionals Pharmacists Optometrists, Psychologists, Acupuncturists, Radiographer, Physiotherapists, Speech therapists, Occupational therapists, Chiropractors, Podiatrists, dieticians and nutritionists, naturopaths, laboratory and other technicians, hygienists or assistants in relation to health services, ambulance officers and para-medics, traditional healers. -Review meeting In 2014, the Office of the Public Service Commissioner (OPSC) established a human resource information management system and policy set to support the proper collection, management and dissemination of information in order to guide workforce planning, recruitment and retention processes, appropriate remuneration and employment conditions, fair and transparent staff performance management, quality controls that include regular assessment and measuring of competencies, access to training and development, and up-to-date workplace Challenges Challenges to maintaining the clinical workforce in the Cook Islands includes: outward migration and attraction to higher incomes and better employment conditions overseas, small numbers of students completing professional training, professional isolation, limited career pathways and opportunities for clinical practice. Additional challenges include an ageing workforce, with a significant number of clinical staff due to retire within the next decade, difficulty in recruiting for outer island positions and limited training and CPD options. Although the Cook Islands meets the WHO minimum threshold of 2.52 well trained healthcare workers per 1000 population, the geographical setting and isolation of small pockets of population in the 5 islands in the north and 6 in the south makes it difficult to provide services equitably. Accordingly, an internal patient referral system is in place. It is anticipated that with CPD for outer islands staff and the introduction of telemedicine that the costs of internal referrals will be contained to some degree. All countries with a HRH crisis have HRH policy and strategic plans. Th ese documents generally identify priorities and establish an action plan for the implementation of strategies to strengthen HRH. In the Region, all plans are integrated into the national health policies Education and training? Geographically, Cook Islands is isolated from the “developed” countries and, to a large extent, from each other. This limitation affects education, training and development. The ability of the country to provide accredited institutions for HRH (Human Resources for Health) training is being limited, therefore, the demand for in-country training can only be fulfilled partially. This condition leads the health workforces to leave Cook Islands and migrate overseas for joining the training program. Developing a skilled workforce is also comprised in the Cook Island’s National Sustainable Plan 2016-2020 (indicator 8.4). Cook Islands is committed to have the most productive society and labour force possible and aspire to increase the proportion of the population that has formal tertiary or vocational qualifications by providing educational opportunities including scholarships, university extension courses, and programmes provided through the Cook Islands Tertiary Training Institute. Cook Islands Government and health sector also have clearly identified the development of a skilled and competent health workforce as a national priority through several plans comprised in the Health Workforce Plan 1998-2020. To support the human resource development, Cook Islands is collaborating through the joint commitment program with New Zealand and Australia. One of