HEALTH POLICY REFORM FOR THE GOVERNMENT OF BELIZE

CAMBRIDGE CONSULTING CORPORATION, under contract with the Government of Belize Ministry of Health & Sports and funding from the Inter-American Development Bank, provided long- and short-term technical assistance in conducting feasibility studies and designing and implementing health policy reforms. As a part of the contract, CAMBRIDGE assumed the responsibility for devising a strategy to shift the emphasis from secondary and hospital care, to primary care and public health. This task included the creation and implementation of a rational and efficient health system that expanded the role of the private sector into alternative organizational arrangements such as private and public-private institutional settings.

In addition, the CAMBRIDGE team designed mechanisms for supervising, monitoring, and regulating the private sector, to include information systems tailored to increase MOH's ability to monitor and evaluate health services in private sector facilities as well as in their own.

CAMBRIDGE also devised and implemented an appropriate cost recovery strategy, which included the establishment of an adequate fee schedule, mechanisms for ensuring that the poor have access to services, and a policy awareness campaign to bring this new information to the attention of the public.

The responsibility for developing a comprehensive proposal for improving efficiency in the organization and delivery of health services in Belize was also assigned to CAMBRIDGE. To this end, CAMBRIDGE identified the needs for different categories of health personnel (consistent with Belize's demographic and epidemiological profile) and designed a set of policies for attracting and retaining qualified personnel.

Finally, CAMBRIDGE also developed other strategies regarding access to health services, management, and funding of support services (including drugs, supplies, buildings, and equipment), and prepared and implemented policy, procedures, and system manuals, as needed, to support the recommended policy reforms.

FAMILY HEALTH SERVICES PROJECT

CAMBRIDGE CONSULTING CORPORATION provided technical assistance and commodities to the Salvadoran Demographic Association (SDA) in El Salvador under funding from the Agency for International Development. The purpose of the project was to expand the delivery of birth spacing services to high-risk populations in rural and marginal urban areas and improve the quality and efficiency of these services. A major goal was to increase the number of Salvadoran couples using birth spacing methods from 120,000 in 1988 to 200,000 by the end of the project. Selected maternal health and child survival interventions complemented birth spacing services by increasing both the accessibility and acceptability of family planning.

To help meet project goals, CAMBRIDGE provided a team of consultants in health project management, rural health education, management information systems, procurement and logistics. These experts provided assistance to the SDA on an ongoing basis. Their efforts were complemented by short-term advisors in personnel management, social marketing and advertising, vehicle maintenance, warehousing, quality assurance, and research as well as by a home office backstop team.

Technical assistance activities helped to overcome constraints to service delivery through the reorganization and expansion of Rural Services, expansion of the Social Marketing Program, expansion of the Clinical Services System, development of 12 marketplace clinics and six new satellite clinics in marginal urban areas, the addition of 50 referral private physicians and development of an improved information, education, and communication (IEC) system. Other components were institutional development, including the establishment of a new revenue-generating Central Referral Clinic, policy development, and research.

COST RECOVERY FOR HEALTH PROJECT - Component Two

CAMBRIDGE CONSULTING CORPORATION provided the Egyptian Health Insurance Organization (HIO) with management and technical assistance in developing/adapting management improvements and management information systems (MIS) to meet HIO's needs under funding from the Agency for International Development. Accomplishments included: evaluation of HIO's existing computer system with recommendations for improvements; development of a physical system design and functional requirements to expand the current computer automation; development of a request for proposals (RFP) for the expansion of the computer automation; assistance in the evaluation of proposals submitted in response to the RFP; development of HIO's (first ever) strategic plan; and development of the functional design for the headquarters' MIS.

In addition CAMBRIDGE provided on-going technical assistance in support of the computer expansion in the areas of: training HIO personnel in the concepts and principles of information management and information technology, implementing actions to improve the technical and functional performance of HIO's existing computer system and converting manual data into computer master files for use in the new computer system.

CAMBRIDGE conducted feasibility studies to investigate other areas where computer automation would assist HIO. One study explored the use of computer automation in HIO headquarters to examine the manual systems and processes to determine what, where, and how computer automation would help improve the accuracy, timeliness, efficiency, and cost of record keeping. A second feasibility study investigated the use of computer technology in administering the delivery of health care services to 15 million school children. A third study investigated the feasibility of a central facility to support the computer training needs of all CRHP projects.

CAMBRIDGE assisted HIO in the areas of management and clinical training. After conducting an assessment of management training needs, it planned and coordinated a participant training program for the HIO. In the area of medical training, it utilized professors from Egyptian medical schools to develop 14 lectures, protocols and handouts for courses in infectious diseases, endemic diseases, drug therapy, gastrointestinal diseases, and clinical examination. These courses were given to 8,000 physicians and 16,000 nurses throughout Egypt.

DESIGN AND IMPLEMENTATION OF A COMPREHENSIVE HEALTH INFORMATION SYSTEM

Under a sub-contract with Booz-Allen & Hamilton and funding from the Agency for International Development, Cambridge is currently providing support in the Diagnostic, Requirements Analysis, and Design phases of a technical assistance project for El Salvador's Ministry of Health. This assistance involves a diagnostic of the current El Salvadoran health environment, including a review of the legal, policy, and regulatory elements that influence the design and implementation of health sector information systems. Cambridge is also involved in a comprehensive organizational review of the Ministry of Public Health as well as the development of Business Process Models and the identification of Critical Success factors.

Cambridge personnel are collecting, documenting, and validating detailed functional requirements from all potential user departments of the information systems. In addition, they are developing and validating a systems architecture designed to support the various processing systems and designing systems security elements.

COST RECOVERY FOR HEALTH PROJECT - Component One

CAMBRIDGE CONSULTING CORPORATION provided technical and management assistance to the Egyptian Ministry of Health (MOH) to improve the delivery of basic health care services under funding from the Agency for International Development. Building upon extensive research, which indicated that Egyptians were willing to pay for a higher quality of health care, CAMBRIDGE worked to implement policy and procedural changes to convert selected hospitals and clinics to fee-for-service facilities.

Five facilities were included in the initial pilot project. These basic, community hospitals were renovated and revitalized in various areas. To upgrade the physical facilities, CAMBRIDGE technical staff procured, installed and maintained a vast array of biomedical equipment. To instill the knowledge of these policy and procedural changes, CCC provided technical assistance in all areas of hospital management, administration and operations. Personnel were taught on-the-job as well as in the classroom, and selected persons joined in observational tours and participant training abroad. Through its efforts, CAMBRIDGE enabled the MOH to improve the quality of basic health care services for a large segment of the Egyptian population.

For Suez Canal University, CCC assisted in the preparation for a managed care health system. Assistance included conducting a seminar on managed care alternatives, assessing the financial system at the hospital and performing a feasibility study for a managed care system.

ASSISTANCE PROJECT FAMILY PLANNING AND STD SERVICES (BOTSPA)

CAMBRIDGE CONSULTING CORPORATION, under funding from the Agency for International Development, completed a contract to assist the Ministry of Health (MOH) of Botswana in enhancing their ability to promote, provide and monitor family planning (FP) services and to diagnose, treat and educate clients regarding sexually transmitted diseases (STDs). The goal of the project was to institutionalize appropriate, high quality clinical FP/STD services and related education and counseling provided by staff whose service delivery skills are routinely appraised and upgraded by supervisory personnel.

CAMBRIDGE worked with the MOH and others to design, implement and evaluate a program to train service providers -- principally midwives, nurses and family welfare educators working in local authority health departments, and district and primary hospitals -- in clinical FP and STD skills, in FP and STD education and counseling, and in the reporting and use of FP related data. In addition, CAMBRIDGE assisted in the design of Information, Education and Communication (IEC) materials that were used by service providers in FP/STD education and counseling.

The Project compiled guidelines for forecasting FP commodity requirements, monitoring stocks at the facility and district levels, as well as reporting and using multiple indicators of contraceptive prevalence. These guidelines were incorporated into a FP/STD Management Information System (MIS). CAMBRIDGE also assisted in the training of district level supervisors to appraise the performance of staff and to help staff resolve problems observed during these appraisals.

FOURTH WORLD CONFERENCE ON WOMEN, BEIJING, CHINA AND BEYOND

CAMBRIDGE CONSULTING CORPORATION was under contract with USAID to support the Global Bureau for Research and Development/Office of Women in Development (G/WID) in its preparations for and follow-up to the Fourth World Conference on Women, held in Beijing, China on September 4-15. This overall effort enhanced the full participation of the U.S. Government (USG), foreign governments, and non-governmental organizations (NGOs) in both the Fourth World Conference and the preparatory conference in Buenos Aires, Argentina in 1994 and, through communications and outreach, continued to ensure that the issues raised at the Beijing Conference remained a focus in the USG's development policy, planning and programming.

In assisting the USG's conference preparation, CAMBRIDGE was responsible for the overall coordination of planning efforts, including the management and monitoring of communications activities. CAMBRIDGE efforts included liaison and coordination with governments, NGOs, women's groups, and other organizations in developing countries to promote participation at all levels. When appropriate, CAMBRIDGE also provided technical assistance, gender analysis training and evaluations to NGOs and groups to support their full participation in the Conference. In addition, CAMBRIDGE established and maintained contact with United Nations (UN) agencies and commissions, the State Department's Bureau for International Organizations, and other relevant actors. In host countries, CAMBRIDGE managed field coordination and monitored resources. CAMBRIDGE pre- and post-conference products included progress reports, financial reports, analyses, recommendations, a library of relevant materials and a national report on the USG's progress in implementing the Beijing resolutions.

After the Beijing conference, CAMBRIDGE continued to support USAID, which, taking advantage of the momentum from the Conference, took a leadership role in ensuring its success and long-term impact and promoted awareness of, and resolution of, gender issues. To that end, the role of CAMBRIDGE was expanded to include formulation and implementation of a communications strategy for the Office of Women in Development. This strategy encompassed all aspects of information dissemination and outreach. Further CAMBRIDGE responsibilities included establishment and maintenance of a resource center on Women in Development; management of a monthly seminar series, special events, conferences and workshops; development and dissemination of a quarterly newsletter; development of WID project publications and a database.