Medical Treatment Scheme l Guideline

Guidelines for New Zealand Medical Treatment Scheme

1 Introduction to the Medical Treatment Scheme

The New Zealand Medical Treatment Scheme (MTS) provides specialist medical services in New Zealand, Australia, Fiji and the region for people from a number of Pacific countries where treatment is not available in their own country. Countries currently participating in the MTS include Fiji, Kiribati, Tonga, Tuvalu and Vanuatu.

The mission of the New Zealand Aid Programme of the Ministry of Foreign Affairs and Trade (MFAT) is to "support sustainable development in developing countries, in order to reduce poverty and to contribute to a more secure, equitable and prosperous world".

The MTS operates within the wider context of the New Zealand Aid Programme Health Policy and Strategy which recognises that there is an interrelationship between poverty and ill-health and that good health contributes to sustainable economic development. While the Health Policy and Strategy gives priority to supporting the development of primary and public healthcare services, it is recognised that it is often difficult or unrealistic for small island states to provide a full range of specialist medical services.

2 Guidelines for the New Zealand Medical Treatment Scheme

The following guidelines define the criteria for provision of services under the MTS, the processes for referral and the roles and responsibilities of different stakeholders in the scheme. These guidelines are intended to provide guidance to Pacific countries involved in this scheme and similar schemes (Niue, Samoa, and Cook Islands), New Zealand Aid Programme managers and the Management Services Contractor (MSC).

2.1 Goal of the MTS

The goal of the MTS is that the citizens of Fiji, Kiribati, Tonga, Vanuatu and Tuvalu are healthy and productive. The long term outcome of the MTS is successful clinical outcomes for citizens in Fiji, Kiribati, Tonga, Vanuatu and Tuvalu unable to access specialist services.

2.2. Components of the MTS:

The MTS now has two components:

a) The Overseas Referral Scheme (ORS)

The objective of the ORS is to increase opportunities for men, women and children (who cannot afford it) to access secondary and tertiary treatment not normally available in their home country.

The Overseas Referrals component provides medical treatment in New Zealand, Australia, Fiji or other country in the region, for people from participating countries with a life threatening or seriously debilitating medical condition but with a good prognosis, and who have a prognosis of at least five (5) years of life after their treatment. Some conditions will not be considered for referral.

The programme covers the costs of treatment from arrival until departure in the country where treatment is to be provided. Support costs for accommodation, transport and a small living allowance is available following approval from the in-country Overseas Referral Committee (ORC).

b) Visiting Medical Specialists (VMS)

The objectives of VMS are:

1. To assess and, where appropriate, provide health services in participating countries, according to identified need that are not otherwise available.

2. To maximize opportunities for capability building through activities such as structured training (e.g. seminars for relevant health professionals) and/or on-the-job training of medical, nursing and allied health staff.

The VMS component enables specialists to be sent to countries to provide medical treatment and/or medical assessments. The visits provide opportunities for local medical staff to improve their skills and knowledge.

2.3 Participating Countries

The following countries participate in the MTS: Fiji, Kiribati, Tonga, Tuvalu, and Vanuatu. Samoa, Niue and Cook Islands operate similar schemes through a different process and these Guidelines are also useful for those programmes.

2.4 Contributions

Funds available for the MTS in each participating country are determined annually in the context of bilateral discussions between MFAT and the country concerned.

In consultation with the MSC, the participating in-country ORC will prioritise services between ORS and VMS. The MSC will allocate funding according to these priorities.

2.5 Roles and responsibilities of stakeholders in the management and administration of the MTS

There are a wide range of stakeholders involved in the management and administration of the MTS. These include:

  • the participating country ORC (comprising of, but not necessarily limited to, clinicians and Ministry of Health official(s)
  • the New Zealand-based MSC
  • the treatment hospitals and VMS and
  • MFAT (the New Zealand Aid Programme

2.6. Role of the In-Country ORC

Each participating country operates an ORC. The ORC provides an important means of ensuring appropriate decisions about treatment are made taking into account competing priorities and the likely treatment and post treatment costs.

The ORC must include (but not necessarily be limited to) senior clinicians and relevant health sector officials. The ORC must have a recognised chairperson whose signature must authorise each overseas referral. For some countries approval is required by Ministers of Health and/or the Secretary of Health as part of internal country approval processes.

This ORC is responsible for in-country management of the scheme, including both the ORS and the VMS components. Specific tasks should be carried out in close consultation with the MSC and include:

  • In consultation with the MSC, determining the allocations of services between ORS and VMS annually.
  • Determining which patients should be referred for treatment and that all referrals meet the MTS referral criteria.
  • Ensuring that ORS equity criteria, as set out in clause 3.3, are met.
  • Deciding levels of patient support costs including a living allowance, transport and accommodation.
  • Managing all aspects of the referral until the patient arrives overseas.
  • To ensure that all patients on return to their country can be, and are followed up appropriately including in accordance with discharge recommendations and that the clinician responsible for on-going care is identified on the referral form.
  • Maintaining a patient registry and good records of discharge summaries and follow up appointments are recorded.
  • Ensuring all returning patients to make contact on arrival back in country.
  • Requesting specific VMS visits that are possible within financial resources and carrying out the management tasks set out in clause 4.3.1.
  • Undertaking annual reporting of patient outcomes for both ORS and VMS to the MSC who will report annually to MFAT.

Annually, the ORC must formally notify the MSC of the membership of the ORC and the identity of the Chairperson as well as the approval processes of the participating country. Whenever the composition of the ORC changes, the Chairperson will notify the MSC. Some ORCs employ a MTS Co-ordinator to manage the in-country aspects of the scheme. All ORCs should be supported by an in country coordinator.

2.7. Role of the MSC

The MTS for Fiji, Kiribati, Tonga, Tuvalu and Vanuatu is managed and administered by a MSC contracted to MFAT within the context of these guidelines.

The MSC‟s role is to ensure that the scheme operates according to the approved guidelines and monitors all activities and the use of resources. The MSC approves and organises treatment for all patients referred for treatment by the ORCs and also organises and approves visiting specialist‟s visits when countries request this form of assistance. In addition, the MSC also provides limited support to countries with regard to building the capacity of clinical staff.

The MSC is responsible for developing and implementing a Monitoring and Evaluation (M&E) Plan that will show the outputs and outcomes of the MTS.

2.8. Annual MSC country visits

The MSC will visit Fiji, Kiribati, Tonga, Vanuatu and Tuvalu annually. During these visits the MSC will:

  • Ensure the in-country ORC continues to function effectively and that there is an identified chairperson;
  • With the ORC, review the previous year‟s programme of activities and use of funds;
  • Develop a MTS work plan for the coming year, including if possible:
  • Agree allocation of funds between ORS and VMS and criteria for patient support costs taking equity criteria into account.
  • Identify opportunities for VMS visits including capacity building opportunities for staff that can be integrated with VMS visits.
  • Ensure the MTS guidelines and criteria are widely known and complied with; and
  • Contribute where requested to any specialist workforce planning and capacity building activities

2.9. MTS involvement with Strengthening Specialised Clinical Services Programme (SSCSP)

The MSC is expected to liaise with the SSCSP based at the Fiji School of Medicine and to help ensure that assistance for secondary and tertiary services in Pacific countries is increasingly better aligned with country priorities and plans including for capacity development and coordinate with other similar programmes.