Enabling Better Management of Hospital Finances: the Success of Electronic Registers

July 01, 2020

Enabling better management of hospital finances: the success of electronic registers

Improving the management and amount of internal revenue for hospitals is a priority for the Ministère de la Santé Publique et de la Population (MSPP) in Haiti. However, there are significant delays in allocating public funds to hospitals. Funds are often only available during the last month of the fiscal year, which forces hospitals to rely only on their own revenue when faced with emergencies. This context creates a number of issues, including hospitals that lack needed equipment for administrative work, especially accounting. This situation has become critical with the COVID-19 pandemic, as procurement of personal protective equipment and oxygen tanks was only possible using revenue from the hospitals.

To improve this situation, the USAID-funded Health Leadership Project (HLP) is supporting the MSPP to continue the installation of electronic registers in 12 hospitals and to monitor the functioning of existing registers in 9 of the 10 departmental hospitals and at the Hôpital de l’Université d’État d’Haïti (HUEH). The objectives of the electronic registers are to facilitate accounting (collecting and managing revenue) and to improve the use of resources (managing stock and monitoring services of care) in hospitals.

The first registers, which have been funded by USAID since 2018, were installed before the implementation of HLP and already have a good reputation in the country. Ms. Marie Gréta Roy Clément, Minister of Public Health and of the Population, in an address she provided to the Ministry’s staff in 2019 indicated: “The governance and management of the sector have improved. Internal revenues of our hospitals have significantly increased with the introduction of electronic registers.”

[Electronic registers at HUJ]

HLP scale-up of a proven intervention for increasing hospital revenue

HLP provided both technical and financial support to health facilities to prepare for the scale-up of the installation and use of cash registers.

From March 15 to April 17, 2020, the Direction de l’Administration et du Budget (DAB) of the MSPP performed an on-site mission with support from HLP to assess the functioning of existing electronic registers and to identify the needs for installing new registers.

This assessment was successfully conducted during the COVID-19 pandemic due to its importance for the health system. The team relied on the response plan developed by the MSPP and was practicing social distancing to ensure the safety and protect the health of those participating in the activity. HLP’s advisor for health financing used remote working tools such as video conference software and instant messaging applications to provide support to teams to revise terms of reference and data collection tools.

Following this work and despite the restrictive measures, the DAB was able to carry out a number of visits in the hospitals of the health departments in the west as well as the Hôpital Immaculée Conception de Port de Paix (Nord-Ouest), the Hôpital de la Providence des Gonaïves (Artibonite), the Hôpital Universitaire Justinien (HUJ) du Cap-Haïtien (Nord), the Hôpital de Fort-Liberté, the Hôpital Communautaire de Référence de Ouanaminthe (Nord-Est), and the Hôpital Sainte-Thérèse de Hinche (HSTH) (Centre).

The team provided direct assistance to verify, update, and repair software for the electronic registers’ systems in the hospitals where the machines had already been installed.

Impact of cash registers

[Note: Cash registers in these hospitals were installed prior to HLP]

Electronic registers have been successful in increasing hospital revenue, from a 9% increase at HUEH to a 66% increase at HUJ and a 70% increase at HSTH. Among the hospitals visited, the average increase was 40%.

For hospitals that don’t receive their budget in time, the revenue from the registers allows them to deal with emergencies (most hospitals haven’t received their operations budgets since October 1, 2019). With the COVID-19 pandemic, the money generated by this initiative has enabled the hospitals to rapidly mobilize and purchase the first needed personal protective equipment (gloves, masks, and hand sanitizer).

COVID-19 has highlighted the pre-existing need to strengthen the financial capacity of health facilities, especially those outside of the capital city of Port-au-Prince, to improve the taxation system for local taxpayers and reduce financial dependence on direct payments.

The installation of electronic registers is a significant step in that direction. As indicated by Georges Koné, Technical Advisor for HLP, “The electronic registers contribute not only to a healthy financial management of hospitals but they also help increase the capacities of the hospitals to provide sustainable quality care to patients.” HLP will continue to support the scale-up of cash registers in Haiti by organizing a workshop for hospitals to share their experiences and to install the registers in the 12 hospitals chosen by the DAB and the MSPP.

[Ms. Anne Berline, cashier at the Hôpital Immaculée Conception de Port de Paix; Mr. Josma St-Louis; Mr. Hibart Valny; and Mr. Merzier Jean Ernst, accountant for DAB/MSPP.]