Performance Highlights 2018/19
15 Years of Excellence
Expanding access to NHFCard benefits
Touching More Lives
The National Health Fund continues to expand its reach while positively impacting the quality of life of beneficiaries across varying socioeconomic and age demographics, through its major programmes and initiatives, as part of a thrust to expand its circle of care. Guided by this vision, the Fund was more deliberate in its actions to ensure that customers and stakeholder groups not only receive the best quality service possible but that a larger number of persons would be able to see a difference in their quality of life through the services of the Fund.
With a 5.8% growth in the Individual Benefits Programmes over the similar period last year, the Fund continues to strengthen its mandate and move closer to achieving its strategic goal of increasing access to health services for the Jamaican public. This increase translated to 44,322 new individuals benefiting from the range of services provided by the Fund. This brings the total number of beneficiaries enrolled to 818,563. Of this number, approximately 40% accessed individual benefits through the NHF and JADEP programmes.
Enrollment on the NHFCard Programme experienced growth of 6.2% compared to that of the previous period. 31,445 beneficiaries were enrolled and the year ended with 502,576 beneficiaries on the database; of this number, 315,804 beneficiaries were active. This allowed more Jamaicans to benefit from subsidies to treat 16 chronic illnesses.
There was an 8.5% increase in enrollmentfor the JADEP Programme;
The JADEP improved access to essential drugs to Jamaicans over the age of 60; 12,877 additional persons were able to benefit from this programme expanding the total reach to 315,987 beneficiaries. Of this number, 83,242 beneficiaries were active.
The Government of Jamaica (GOJ) database, which is maintained by the Fund, continued to grow during the year with the additional enrollment of 37,245 individuals resulting in a total of 648,392 beneficiaries including 164,892 GOJ cardholders. Public patients with NHF or GOJ cards are able to use their cards to access Vital Essential and Necessary (VEN) Drugs under the Government programme, at public sector pharmacy facilities. They may also use these cards at pharmacies across the island that provide dispensing services to public sector patients through their participation in the Public Sector Pharmacy Partner Programme (PSPP) .
Protecting the vulnerable
The expansion of the NHF services to the vulnerable continued with the introduction of the Special Registration Number (SRN) in September 2018. This created an avenue that ensured that vulnerable individuals such as senior citizens, children and adults who live in state-owned or private institutions and do not have birth certificates are still able to access NHF services. The SRN does not replace the TRN, which is a mandatory requirement, but serves as an alternative for processing applications for individuals in these extraordinary circumstances. At the end of the financial year, 493 beneficiaries were enrolled under the SRN initiative. This number is expected to increase over time, as we continue to broaden our reach. Demonstrating Care – Reaching Customers Everywhere
There was a 10% rise in customer service interactions across locations compared to 2017-2018 which can be attributed to the expansion of the Same Day Card locations . During the period, 17,259 calls were handled by the Contact Centre as well as 78,787 visitors were served at our locations. The majority of these activities occurred at Head Office located at Dominica Drive. Help Desk services continued to be available at Union Square Drug Serv Pharmacy, Mandeville Regional Hospital, St. Ann’s Bay Hospital, Cornwall Regional Hospital and May Pen Drug Serv Pharmacy.
The increase in enrollment and the 10% rise in customer service interactions were, in part, due to the many initiatives the NHF implemented during the year to expand reach, improve access and enhance customer satisfaction. The Same Day Card Service, which allows persons the opportunity to receive their health cards within 30 minutes, was expanded with the addition of three new Drug Serv locations in Trelawny, Hanover and Portland. This ensured island-wide coverage as each parish now has at least one location that provides same day card application processing service. The new locations increased the overall number of Same Day Card Service locations to seventeen.
With regard to card production activity during the year, the total number of new and replacement cards was 72,622, and of this number, 89% represented cards generated via the Same Day Card Service ; 74% of cards produced were for NHFCard beneficiaries with the remainder being JADEP cards and to a lesser extent, GOJ cards.
With a view to further enhance customer-experience and deliver a service that is more responsive to the needs of Jamaicans, the NHF improved its operational excellence by streamlining its customer service operations across the organisation. This led to the customer service function being centralised in the Customer Care Department thereby expanding its role in service delivery. This new development led to increased gains for the Fund as service levels were improved and a wider range of services, including cheque processing and disbursement, were offered from one location.
The National Health Fund continued to service an extensive network of NHFCard, JADEP and PSPP providers which offer beneficiaries access to multiple options for filling prescriptions across the island. There was an expansion of the NHFCard and JADEP provider networks during the year with the addition of 30 new pharmacies. In addition there were 53 terminations due to the closure of business operations. The year ended with a network of 476 NHFCard providers and 283 JADEP providers island-wide providing prescription services to beneficiaries. In addition, 52 Public Sector Partner pharmacies signed contracts to provide prescription services to public sector patients.
In keeping with our drive to ensure high service standards, a number of pharmacy site visits were conducted by a multidisciplinary team from within the organisation in order to educate, build and maintain good relations with providers. Follow-up activities and provider consultations were conducted to ensure optimum operations and smooth transition of JADEP stock ownership from NHF to the pharmacies.
Expanding Pharmaceutical Access for Public Patients
During the financial year NHF’s circle of care expanded with the complete takeover of management of all public sector pharmacies in April 2018. The Agency made significant strides in expanding access to pharmaceutical services for public patients, as well as improving the overall service experience.
Drug Serv Pharmacy Services
Given the mandate to improve services to public sector patients, the organization set out to achieve Key Performance Indicators (KPIs). Improvements included increased use of Alternate Service Options (ASOs), a reduction in the wait time for out-patients and the piloting of Mobile Dispensing Units (MDUs) to enhance in-patient services. The Medication Safety Programme, was also implemented during the year.
The Pharmacy Inventory Management System (PIMS), used by the NHF for the management of pharmacy information and inventory, was implemented across all full-service pharmacy locations by the end of the fiscal year. With the inclusion of all public sector pharmacies a total of 2,554,961 scripts were filled during the 2018/2019 financial year. This bettered the 2017/18 performance of 1,278,119 by 100%.
The NHF made another huge leap in service delivery with the introduction of the Quick Prescript Application. Quick Prescript is a mobile application which provides public health patients a fast and effective method of submitting their prescriptions to Drug Serv pharmacies. Patients take a photograph of the prescription and upload it to the Quick Prescript app via their telephone or Kiosks provided at various locations. Patients are then contacted through Live Chat or SMS messages to notify them that their medication is ready for pick up at their selected Drug Serv Pharmacy.
In order to bring the Drug Serv Pharmacy Service to international operating standards, NHF has began the process of preparing pharmacies for ISO certification. As a result, four pharmacies achieved ISO certification and the number is expected to increase during the 2019/2020 fiscal year.
Through the execution of a number of clinical interventions, a total of 9,002 drug related problems were documented during the year. These related to effectiveness of Dosing selection; Analysis of drug selections, Patient /Provider Care and Drug toxicity (Adverse Drug Reactions). The interventions made by pharmacists resulted in greater medication safety, changes in therapy and better patient outcomes.
The clinical intervention breakdown is shown in the graph below:
Waiting Time And Service Level
The NHF’s commitment to improving service standards was further proven through a general lowering of waiting time. The targeted average wait time of 60 minutes or less was achieved by March 31, 2019, having attained an actual average of 56 minutes.
Forging Partnerships For Expanded Care
The Public Sector Pharmacy Partner Programme continues to be one of the main vehicles used to expand the reach of the NHF services. Through this programme, NHF drugs are dispensed via participating private pharmacies which increases the existing avenues that Jamaicans with prescriptions from public hospitals and clinics can use to access specific Vital, Essential and Necessary (VEN) prescription drugs. Since its launch in 2017 with 5 pharmacies, the programme has since expanded to 49 as at March 2019.
In 2018/19 the overall average wait time at the PSPP providers was 126 minutes. However, twenty-three (23) of the pharmacies had an average wait time of
thirty-six (36) minutes. The average recorded service level was 91% with many achieving a service level between 95-100%.
In order to ensure that operating standards were being adhered to, there were 476 ward checks carried out across 56 hospitals during the 2018/2019 period. The checks focused on proper medication storage practices, expired/damaged items, medication excess and low stock/ out of stock items and redistribution of items.
Alternate Service Options
For the Fiscal year ending March 31, 2019, 646,239 scripts were filled using the alternate service options. This represented 30% of the 2,156,620 outpatient scripts that were filled over the period (see table below)
• Special /Priority Services
Special /Priority Services were provided for patients filling 75,169 scripts. This represented 4% of the 2,156,620 outpatient scripts that were filled in 2018/2019.
Mobile Dispensing Units
Designed to introduce and maintain medication therapy management, the Mobile Dispensing Unit (MDU) is a cart equipped with a computer, pharmacy software, label and receipt printer, containers, and the commonly prescribed medications for each firm. A Clinical Pharmacist manages the MDU, and dispensing activities are executed while patients are being treated/cared for on the ward and at the point of being discharged.
The desired outcome was to reduce turnaround time as well as to optimize patient outcomes and improved quality of life. The MDU was piloted in April 2018 and service is offered at the Bustamante Hospital for Children, Kingston Public and the Mandeville Regional Hospitals. Service began at the May Pen Hospital in February 2019.
Nine MDUs and accompanying medication cabinets were procured for the appropriate storage of patients’ medications.Four of which are now operational. For the period April 2018 to March 2019, the MDUs served an average of four wards each month at four hospitals.
Pharmaceutical Warehouse Secures Availability of Supplies
To ensure the availability of supplies, the NHF worked to maintain adequate stocks of VEN list items according to budgetary allocation. To this end, the agency has an internally defined objective to ensure that a minimum of 80% of VEN list items are in stock at the warehouse each month. For the 2018/2019 financial year, an annual average stock level of 84.6% was achieved, this was a marginal decline over the previous year’s attainment of 86%. The table below gives the stock level of VEN List items for each month.
The service level of the Warehouse is measured on a monthly basis, comparing order quantities of medication against quantities supplied inclusive of those used in the treatment of chronic diseases (hypertension, diabetes, asthma, mental illness and cardiac disease). For the fiscal year 2018/2019 the annual average service level for all items was 80% compared to 87% for 2017/2018 financial year , while the service level for drugs used in the treatment of chronic illnesses was 81% compared to 82% for the previous year.
The monthly delivery schedule allots two deliveries per month to each health institution, with the exception of Drug Serv pharmacies located in Kingston, where weekly deliveries are made. For 2018/2019 financial year the NHF experienced challenges with maintaining compliance to the delivery schedule as two separate tenders to increase the number of haulage contractors engaged to deliver orders failed to yield any successful bid. The main factors affecting the attainment of full compliance with the delivery schedule were the challenges with the delivery fleet and the late submission of orders from health institutions.
Improved Warehouse Efficiency
Optimization of operations across all divisions in the organization is a key imperative in maintaining our reputation as leaders in public sector service delivery. For the 2018-2019 period, gains were made in several areas in the Warehouse. Improvements in inventory management were the result of improvements in monitoring procedures including more robust investigation of variances, increased inventory counts by inventory officers and weekly cycle counts by the Finance Department. The findings by the Finance Department showed that of the 4,369 counts that were conducted, less than 2% had variances at the end of the financial year.
The NHF was also able to surpass its spoilage rate target of ≤ 0.5% of annual inventory value by recording an actual inventory spoilage rate being 0.14% of the average annual inventory value compared to 0.07% for the previous year. There were also improvements in inventory turnover rates.
One major improvement occurred in the order and procurement process which lead to a 30% reduction in inventory value which reflected better management, as ordering was reduced.
The NHF’s commitment to customer satisfaction remains unparalleled as the Warehouse Division achieved a customer satisfaction rating of 91% based on NHF’s Annual Customer Satisfaction Survey. This is an improvement over the 86% achieved for the previous year. All 221 customer complaints received during the period were resolved.
NHF Grants and Projects
The National Health Fund, as part of its mandate, offers funding through grants for the improvement and development of healthcare systems to ensure the adequate provision of healthcare for all Jamaicans.
For the 2018/2019 financial year the NHF approved, implemented and maintained critical equipment and infrastructural upgrades at an approximate cost of $1.8 Billion,
with the breakdown as follows:
- Approval of Institutional Benefits projects -$1.76 billion
- Implementation of Capital projects -$144 million
- Renovation of 23 Pharmacies - $65 million
- Joint collaboration with the Regional Health Authorities for our Community Work days – $20 million
- Maintenance of critical equipment (Preventative and Corrective) -$14 million
Project Approvals – Institutional Benefits
During the year approximately $1.76 billion was approved for 35 Institutional Benefits projects with $765.55 million approved for 26 new projects while additional funding of $997.77 million was approved for 9 existing projects.
Approval by Grantee
Regarding approval of projects, The Ministry of Health & Wellness commanded the largest share of funding approved for the FY 2018 / 2019 financial year. The allotments are outlined in the diagram below:
RJR Gleaner Honour Award
One of the highlights was the RJR Gleaner Honour Award made to the NHF in the category of Health & Wellness for its success in increasing access to affordable health care for a wide cross-section of Jamaicans.
Douglas Orane, Chairman of the RJR/ Gleaner Awards Committee presents Everton Anderson with the Honour Award in the category of Health and Wellness for the work that National Health Fund is doing, at the Gleaner Honour Awards luncheon held at the Gleaner on Monday, January 14, 2019. - (2019) The Gleaner Co. (Media) Ltd.
The NHF team was able to maintain financial stability and achieve a creditable financial performance for the year ended March 31, 2019, while providing high service levels in carrying out the mandate for the management and delivery of pharmacy services within the public health sector with an inadequate drug budget.
The Statement of Financial Position as at March 31, 2019 reflects a net asset position of $12.83B, which declined by 1.37% ($178.58 million), when compared to the $13.01B reported at March 2018. These results were negatively impacted by a provision for impairment totaling $7.08B ($5.06B in March 2018) booked against the General and Trust Funds.
The chart below provides a comparative of significant Balance Sheet items year over year:
The financial position is reflecting a current ratio of 3.05:1, and an acid test ratio of 2.60:1, after adjustment for impairment of Receivables and Investments. The current and acid test ratios for the comparable period were 4.30:1 and 3.55:1, respectively.
Trade Receivables due from the MOH&W, totalled $5.18B at March 31, 2019. However, $5.17B of the total amount outstanding was impaired, resulting in a net Receivable of $2.08 million in the Balance Sheet at year end. These results, when compared to the $5.17B due from the MOH&W, and impairment provision of $4.26B at March 2018, reflects an additional impairment provision of $917.48 million year over year.
Other Receivables of $1.47B as at March 31, 2019 shows a decrease of 37% ($879.39 million) when compared to $2.35B reported for the prior year. The balance includes Taxation Revenue Receivable which amounted to $645.86 million (2018:$1,056.14 million), and is net of provision for impairment of $1,565.49 million at March 2019, and $796.86M in the prior year.
Total Accounts Payable, which includes Trade Payables, Accruals and Other Payables, amounted to $2.66B at March 31, 2019, and reflects an increase of $942.95 million when compared to the balance reported at March 31, 2018. This increase was primarily as a result of an advance payment received from the MOH&W of $1.07B at the end of the year.
Trade Accounts Payable of $0.90B represents amounts owed to suppliers of pharmaceuticals and medical sundries; this balance decreased by 22.94% ($268.94 million) when compared to March 2018.
Total Institutional Benefits Payable of $1.24B at March 2019 reflects a reduction of $383.69 million when compared to the position March 2018. Grant approvals for the financial year amounted to $1.77B whilst payments totaled $2.11B.
The General Fund amounted to $0.38B, which was a reduction of $1.48B when compared to the balance at March 2018, and was negatively impacted by the IFRS 9 provision for impairment of Accounts Receivable and Investments. During the period $2.29B was transferred from the General Fund to finance Institutional Benefits projects. The Trust Fund Reserve stood at $10.20B at March 31, 2019 which is an increase of 7.52% ($712.95 million) when compared to March 2018. The increa
in this Reserve was a net result of interest income of $371.11 million, transfer from General fund of $436.56 million, foreign exchange loss of $53.80M, and provision for impairment of $40.92 million during the year.
Income and Expenditure
The surplus for the year ended March 31, 2019 of $2.85B reflects an improved performance when compared to the deficit of $12.57 million for the period ended March 31, 2018.
Total Revenue net of expenses for the year reflected an increase of $1.27B or 12.15% when compared to March 2018. The increase is due to revenues from taxation sources (Tobacco Tax, National Insurance and Special Consumption Tax) and other income increasing over prior year by $733.26 (9.17%) and $766.17 million (33.76%), respectively; offset by a decline in revenue from the provision of pharmaceuticals and medical sundries by $231.11 million.
Expenses for the year amounted to $8.84B which is a reduction of $1.61B when compared to prior year. The main factors contributing to the change in expenditure year over year are as follows:
Provision for impairment was $379.97 million, compared to $3.06B recorded for the period ended March 31, 2018 as a result of IFRS 9 transitional adjustments booked in the prior year.
Benefit Costs (NHF & JADEP Cards) of $5.10B representing 57.67% of Total Expenditure, reflected an increase of $293.04 million when compared to March 2018, due ssolely to an increase in card utilization year over year. Health Promotion and Public Relations expense was $160.22 million, compared to $166.17 million at March 31, 2018, and accounts for 1.81% of Total Expenditure.
Staff Costs of $1.76B represents an increase of 33.14% or $438.43 million over the previous year. The increase is mainly due to increased costs relating to the take-over of the staff in all public sector pharmacies; and an annual salary increase of 5% granted by the Government to public sector workers.
Administrative and other expenses for the current year amounted to $1.44B resulting in an increase of 30.56% ($337.10 million) over prior year. This increase was primarily as a result of costs associated with the maintenance and management of additional locations taken over during the year.