The undermining principle of the ASA is to achievea balance between the resources available to undertake the work and the level of workload, which is a fundamental stone in enabling organisations to provide high quality service to others.In introducing the ASA, it is important that the staff and the TRHA on the whole recognises that the ASA is not a blame game, not a paper exercise and not intended to be a punitive framework. A service agreement enables the Commissioners (DWFD) and the Service Provider (TRHA) to:•agree the amount of work that is possible for an agreed budget and,•agree the quality of the service that is to be provided. It also contains an agreed mechanism whereby a shift in the workload, or a change in case-mix, will result in a variation of either: the amount of income transferred from the commissioner of the service to TRHAor (ii) the agreed workload.The ASA is needed to address inherent flaws in the existing health systems that include:•No clearly documented mandate given to TRHA Board•No collaboration on healthcare priorities•No clearly defined roles and responsibilities for specific areas•No clearly defined structures for reporting: format nor timelines•Not enough accountability – on both sides!It is anticipated that a properly executed ASA will:18
MSc Global Health Systems, Theory and Policy •Promote clear goals, objectives, and processes for monitoring and evaluating results•Enable a learning culture and environment based on continuing evaluation; and •Help to define clear accountabilities and responsibilities in a decentralized and de-concentrated context •Help identify barriers to achieving better results •Highlight bottlenecks in planning and budgeting processes •Point out uncertainties in institutional and organizational arrangements, especiallyamong central government, DWFD and the TRHA’s roles and responsibilities A successful adoption of the ASA will answer questions such as: Are clients satisfied? Are clients getting quality service? Are the programmes being run by the TRHA on behalf of the DWFD effectiveness or even cost-effective? Is the provider (TRHA) meeting its objectives? Are the strategic priorities agreed upon by commissioner and the provider being met? Is there continued need for certain programs (Does the initial rationale still exist)? Do current programs need to be altered? An ASA will create a clear mandate for performance expectations and deliverables for theTRHA Board and ensure timely collaboration and sharing between the DWFD and the TRHA of the strategic health priorities for Tobago. It will allow for the distribution of allocated funds in an agreed and scheduled manner and facilitate and support developmental activities presented by TRHA Board as long as the DWFD is satisfied thatit is in the best interest of health in Tobago at the time.
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