CDAP Smart Card Solution
Governance Framework
Draft for Discussion
November 2005
Document Revision Control
Revision
Number
Date
Revision Author
Description
1.0
2.0
2.1
11/11/05
21/11/05
28/11/05
Lisa Chote (PSTG)
Lisa Chote (PSTG)
D. Belmonte (PSTG)
Template developed
Input from D. Belmonte
Edits / input
CDAP Smart Card Solution: Governance Framework
Table of Contents
1.0 Introduction................................................................3
2.0 CDAP Smart Card Solution Governance Goal & Objectives .........4
3.0 The Governance Framework ............................................5
4.0 Summary and Next Steps .............................................. 17
CDAP Smart Card Solution: Governance Framework
1.0 Introduction
The purpose of this document is to define the authority structure,
accountability relationships and responsibilities of all the entities
associated with the administration, management and delivery of the
Chronic Disease Assistance Programme (CDAP) IT system solution.
This Governance Framework should be in place to ensure that a
proper decision making process exists to support both the programme
and the supporting IT solution. In developing the framework, every
effort has been made to place adequate accountability at all levels
and to clearly articulate roles and responsibilities for each
participating institution and committee.
Several workshops were delivered and feedback and input were
encouraged from all stakeholder groups. This paper documents the
findings of the workshops and recommends a way forward to
establish an appropriate governance framework.
The workshops revealed that the mechanisms by which the CDAP
Programme is currently governed are in need of updating and reframing. Many relationships among the various parties are not
documented and nor are they clearly defined, leading to unclear
accountabilities and relationships. This document therefore serves as
a reference guide for the implementation of an appropriate
Governance Framework in support of the CDAP IT solution. The
framework also addresses governance issues involved in management
the overall CDAP programme by defining accountability mechanisms
that will help clarify and strengthen the overall administration of
programme itself.
CDAP Smart Card Solution: Governance Framework
3
2.0 CDAP Smart Card Solution Governance
Goal & Objectives
The goal of the CDAP IT Solution governance framework is:
“To define authority, accountability and responsibility levels to
support the implementation and efficient use of the CDAP smart
card solution, and engage all stakeholders and delivery partners in
providing quality service to CDAP patients”
This goal is supported by several objectives, including:
1. To provide support and service to the Cabinet, the Ministry of
Health and NIPDEC in delivering a quality solution to CDAP
patients;
2. To listen to users and stakeholders and adjust the solution to
meet their needs;
3. To ensure continuous improvement and evolution of the CDAP
Smart card solution and by extension, the CDAP programme;
4. To continuously evaluate the solution’s performance and
improve where possible;
5. To develop clear processes and mechanisms for easy
participation in and management of the smart card solution;
6. To provide mechanisms for monitoring the growth and use of
the programme and maintain its transparent audit process;
and,
7. To provide support and guidance to the Ministry of Health and
the Government of Trinidad and Tobago in their effort to
engender electronic service delivery transformation.
CDAP Smart Card Solution: Governance Framework
4
3.0 The Governance Framework
Today’s Environment:
At present, the Ministry of Health is accountable for the delivery of
the CDAP Programme to the nationals of Trinidad and Tobago.
The procurement and distribution of the drugs has been awarded to
National Insurance and Property Development Company (NIPDEC) and
the drugs are delivered to the patients through the public and private
pharmacies. At present, this operation is loosely defined and
designed, and very few structures are in place to assign authority and
responsibility to monitor and evaluate the programme.
Diagram 1 on the following page illustrates the CDAP governance
environment. A proper government framework must clearly define
the responsibilities of each entity and their respective roles in the
administration and delivery of the programme. Given the
organisational entities involved, the following represents their
current roles in the overall governance of the programme:

Ministry of Health: Represents the owner of the CDAP
programme and has the legislative and budget authority and
control;

CDAP Steering Committee: Represents the “administrator” of
the CDAP programme and manages the programme on behalf
of the owner (Ministry of Health);

NIPDEC: Represents the service delivery agent for the CDAP
programme on behalf of the CDAP “administrator” and
“owner”;

Programme Partners: Represent key stakeholders of the
programme – those who have an interest in how the
programme is managed and delivered, e.g., Pharmacy Board,
Medical Boards, Regional Health Authorities;

Delivery Partners: represents those who assist the service
delivery agent (NIPDEC) in the delivery of the CDAP
programme or are involved in the CDAP delivery, e.g., private
and public pharmacies.
CDAP Smart Card Solution: Governance Framework
5
Diagram 1 – CDAP Governance Environment:
Cabinet
Ministry of Health
CDAP Steering
Committee
CDAP Programme
Service Delivery
NIPDEC
CDAP Programme
Management Team
& Operations
Service delivery partners
IT Solution and
Support
Contractor
Regional Health
Authorities
Pharmacy
Board
Medical Board
& Doctors’
Associations
Pharmacists
(public)
Pharmacists
(private)
Doctors
Pharmaceutical
Suppliers
CDAP
Patients
TT POST
Refining CDAP’s Governance Framework
Today, the inter-relationships between the Ministry of Health, its
CDAP Steering Committee, NIPDEC and other partner stakeholders
are not as clearly defined as they could be. Generally, these interrelationships are governed by loosely defined formal and informal
practices, which lead to confusion and an inconsistency in the overall
administration of the CDAP programme.
With the development and deployment of an IT smart card solution in
support of the CDAP programme, an ideal opportunity exists to
clearly assign authority, accountability and responsibility to each
entity participating in the provision of service. It also provides the
opportunity to document and agree on each party’s role in the larger
CDAP Programme. The redefined governance framework for CDAP
must define the relationships between and among all the entities
that are involved in the programme and clearly articulate their roles,
mandates and responsibilities and authorities.
Strengthening the Role of the CDAP Steering Committee
A key feature of the refined governance framework is to establish the
CDAP Steering Committee as the overall programme management
CDAP Smart Card Solution: Governance Framework
6
body. As the Ministry of Health is the lead Ministry for the CDAP
Programme, it will benefit from setting up the CDAP Steering
Committee to act as a central agency to manage the delivery agency
– NIPDEC – and NIPDEC’s programme and delivery partners.
Establishing a CDAP Steering Committee and investing it with the
authority to manage the entire CDAP Programme and the Smart Card
Solution also offers opportunity for aligning the smart card solution
with other government-wide electronic service delivery initiatives.
It is also recommended that the Steering Committee’s focus be to
manage every aspect of the design and delivery of the CDAP
Programme and to ensure that the programme goals and objectives
are met. It will focus on the CDAP smart card delivery solution and
set standards by which the delivery agent manages same. Its task is
to collaborate with the programme partners to ensure that the users
of the programme receive consistent quality service.
In addition, the Steering Committee will review the CDAP strategy,
provide direction on key issues such as drug and disease expansion
and eligibility, and evaluate the impact of the programme on the
lives and welfare of the nationals of Trinidad and Tobago. The
Ministry must also charge the Steering Committee with such
responsibilities as deciding on funding requirements for the
programme, reporting requirements, dispute resolution and
maintaining the public trust in the programme and the supporting IT
solution.
For the governance structure to work properly, the Ministry of Health
must also clearly define the roles and responsibilities for the
Programme partners such as the Regional Health Authorities, the
Medical Board, and the Pharmacy Board. At present, there is no
definition of what input is required by any of these entities in
supporting the CDAP programme.
Several organisational entities define the overall governance
framework required to support the CDAP Smart Card Solution. Each
entity has specific accountabilities and responsibilities to ensure that
all CDAP programme and smart card solution requirements are met at
the executive and operational levels of the government and that the
expectations and needs of the users are addressed. More detailed
information on each entity, their roles and responsibilities are
provided on the following pages.
CDAP Smart Card Solution: Governance Framework
7
Ministry of Health
The Ministry of Health has the final accountability and responsibility
for the CDAP Programme and the CDAP Smart Card Solution. The
Minister of Health is charged by Cabinet, with ensuring that CDAP
drugs are delivered to nationals of Trinidad and Tobago. The Minister
of Health is supported by his Advisor, the Permanent Secretary, the
Chief Medical Officer, the Government Principal Pharmacist, and
various committees such as the Central Drug Advisory Committee &
Formulary Committee, and the CDAP IT Steering Committee. The
Minister is also advised by the Pharmacy Board, the Medical Board,
the Regional Health Authorities and representatives of NIPDEC.
At present, there are no formal mechanisms for the overall
management and review of the programme and/or the smart card
solution. Other than a dated contract with NIPDEC to procure and
distribute CDAP drugs, there are no other formal memoranda of
understanding or terms of reference for any of the committees which
guide and influence the programme. As a result, there are no service
standards and other performance measures to evaluate the
programme.
The Ministry of Health role and core responsibilities will continue to
remain as they are today with respect to the CDAP programme. As
the programme owner, it has a responsibility to clearly define a more
comprehensive administrative structure that will coordinate the
efforts the programmes key stakeholders and other supporting
committees. The following table summarises the Ministry of
Health’s role, responsibilities and authority regarding CDAP.
CDAP Smart Card Solution: Governance Framework
8
Ministry of Health
Ensures that all residents of Trinidad and Tobago have access to and receive
appropriate drugs in support of chronic diseases.
Ministry of Health Executive
Team:

Minister of Health or his designated
representative;

Permanent Secretary of Health;

Government Principal Pharmacist;

Chief Medical Officer;
Accountability Relationships
Cabinet
Ministry of
Health
Authority

Approves CDAP Programme strategy,
plans and budget;

Approves all major policy, e.g., drug
expansion, etc.
CDAP Steering Committee
Responsibilities












Act as the administrator for the CDAP Programme;
Evaluates progress and the continuous development of the CDAP
Programme and its performance;
Monitor and evaluates the Steering Committee’s performance in
meeting the goals and objectives of the CDAP Programme;
Provide guidance and approval on programme expansion for diseases
and drugs;
Ensure that the smart card solution aligns with overall governmental
strategic directions and specifically on the government wide electronic
service delivery strategy;
Selects and appoints CDAP Steering Committee members ;
Assist the Steering Committee in working with new and existing
programme partners and other relevant Committees within the
Ministry;
Promote the programme to the public and other government agencies;
Ensure that public feedback on the programme is treated with the
required response;
Ensure that the financial and operational aspects of the programme are
performed transparently in keeping with the public’s trust;
Execute contracts and service level agreements with delivery agent;
Create terms of reference for all Committees.
CDAP Smart Card Solution: Governance Framework
9
CDAP Steering Committee
The key role within the Ministry of Health is the CDAP Steering
Committee. The Steering Committee acts as the overall Manager of
the CDAP Programme and will be responsible for directing the
delivery agent and the programme partners in delivering seamless
and continuous service to the community of CDAP patients. The
Committee reports to the executive of the Ministry of Health on the
status of the programme and facilitates discussion on resolving issues
and key decisions.
CDAP Smart Card Solution: Governance Framework
10
CDAP Steering Committee
Champions the CDAP programme and the smart card solution to ensure that the
programme meets its goals. Works with programme partners to provide strategic
guidance on programme expansion and performance.
Composition
Accountability Relationships
The Minister of Health‘s designate;
Representative of the Pharmacy
Board;
 Representative of the Medical
Board;
 Representatives from the RHAs;
 NIPDEC Programme Manager;


Ministry of
Health
Authority
Delegated authority from the Minister of
Health to:
CDAP Steering Committee
 Recommend CDAP Programme
strategy, operational plan and budget;


Recommend all initiatives related to
achieving the programme strategy and
maintaining operation of the smart
card solution;
NIPDEC
Pharmacy
Board
RHA
Medical
Board
Recommend service delivery contracts
and manage service provider;
Responsibilities







Overall Champion of the CDAP Programme and the Smart Card Solution, providing
strategic advice on programme evolution;
Provide direction and guidance to the Ministry of Health on programme
expansion;
Report to the Ministry of Health on progress and performance of the programme;
Create relevant Memoranda of Understanding with partners;
Collaborate with programme partners to ensure that appropriate levels of service
are delivered;
Execute Service Level Agreement and evaluate the delivery agent and its
partners;
Promote the programme to the citizens of Trinidad and Tobago;
CDAP Smart Card Solution: Governance Framework
11
NIPDEC and its Delivery Partners
NIPDEC functions at the operational level are to procure and
distribute CDAP drugs to the public and private pharmacies. NIPDEC
will also manage the IT infrastructure to support the new smart card
solution. NIPDEC collaborates with the Ministry of Health and the
CDAP Steering Committee to execute the strategic direction of the
Ministry. It also provides statistics and value added information to
influence the evolution of the programme and the solution.
Defining the New CDAP Operating Environment:
The proposed IT smart card solution will significantly change the
existing CDAP operating environment and with it introduce several
new service relationships that do not exist at present. Today much
of the delivery process is paper-based, with CDAP users, pharmacists
and NIPDEC staff handling and managing thousands of paper
prescriptions forms. With the introduction of CDAP smart cards, the
paper based process will no longer be required. Automating this
process will allow users to present their cards that will contain
prescription information to their local pharmacy, who in turn would
read the card information using a terminal reader device.
Prescriptions will be completed and information related to that
transaction stored and sent to NIPDEC for further processing.
It is also envisioned that the IT CDAP smart card solution will be
managed and delivered by a third party vendor on behalf of NIPDEC.
This vendor would be responsible for card management and providing
maintaining the CDAP It solution. In addition, the CDAP application
housed by the terminal reader will be leased by NIPDEC on behalf of
pharmacists. Terminal readers will be owned by the IT service
provider and leased to pharmacists. It is envisioned that these
terminals will not be used for CDAP applications only; rather other
commercial applications can be supported and used by private
pharmacies as a means to offset costs and generate alternate sources
of revenue, e.g., selling of air time.
CDAP Smart Card Solution: Governance Framework
12
NIPDEC
Procures and distributes CDAP drugs to the public & private pharmacies with
continuous, seamless service and efficient claims management. It also manages the
IT infrastructure and smart card solution to provide added value to the Ministry of
Health, the pharmacies and the CDAP Patients.
Composition

NIPDEC and C40 staff, IT Vendor, TT
Post & pharmaceutical companies
operate and execute the
programme, claims management
process and the smart card solution.
Accountability Relationships
CDAP Steering Committee
NIPDEC
CDAP
Programme
Management
Authority

Manage all CDAP programme
operations;

Recommend for approval the
necessary tasks and investments to
deliver on the programme’s mandate

IT Solution
Provider
Pharma
Suppliers
Monitor the performance of the
delivery partners according to defined
service level agreements;
TT Post
Responsibilities







Manage all CDAP prescription inventory and distribution to private and public
pharmacy – handles all supply chain from source, receipt and inventory and
distribution;
Process all claims, financial payments and reconciliation with pharmacists;
Manage and maintain all supporting CDAP IT infrastructure;
Establish agreements and contracts with delivery partners with appropriate service
contracts and other monitoring mechanisms;
Develop annual operating plan and budgets, develops policies, and recruits
appropriate resources to manage and operate the execution of the programme and
implement improvement initiatives and major strategic components;
Provide relevant statistics and reports to provide feedback to the Steering
Committee;
Ensure that the programme and the solution meet citizen/user needs and
expectations;
CDAP Smart Card Solution: Governance Framework
13
NIPDEC and the Pharmacies
NIPDEC procures and distributes CDAP drugs to the public and private
pharmacies. NIPDEC contracts with each of the pharmacies to
distribute CDAP drugs and manage the programme’s operations and
inventory through the smart card solution. The pharmacies will also
have responsibilities for patient registration and enrollment.
Private and Public Pharmacies
Dispense CDAP drugs to eligible residents of Trinidad and Tobago.
Who’s Involved

Private pharmacies and pharmacists
who are employed by the private
enterprise;

Public pharmacies and pharmacists
who work in those facilities;
Accountability Relationships
NIPDEC
CDAP
Programme
Management
Authority

Dispense CDAP drugs to eligible CDAP
patients;

Register and enrols patients for CDAP
smart cards;

On-site inventory levels;
Private
Pharmacies
Public
Pharmacies
Responsibilities





Enter into contract with NIPDEC to dispense drugs to patients using the smart card
solution according to specific procedures, policies, and standards.
Manage CDAP inventory levels, process claims, etc, according to CDAP procedures;
Enroll CDAP patients to receive programme smart card and distribute cards to
users;
Provide feedback to NIPDEC on user satisfaction or delivery concerns;
Ensure that the programme and the solution meet citizen/user needs and
expectations;
CDAP Smart Card Solution: Governance Framework
14
NIPDEC, the IT Solution Provider and the Merchants
NIPDEC works with the IT Solution Provider to design and maintain
the back-end solution, the terminal solution space and the smart
cards. The IT Solution Provider will work independently with the
merchants and the RHAs to lease and support the terminals.
IT Service Provider
Manage, on behalf of NIPDEC the IT infrastructure and smart card solution to provide
added value to the Ministry of Health, the pharmacies and the CDAP Patients,
according to set standards. In addition, the IT Service Provider will provide terminal
support to merchants (pharmacies).
Who’s Involved


Accountability Relationships
Service Contract between NIPDEC
and IT Service Provider for card
management and IT support
services;
Merchant agreement between IT
service provider and private
pharmacists for terminal support;
NIPDEC
CDAP
Programme
Management
IT Service
Provider
Authority

Defined within the terms and
conditions of negotiated service
contracts, including service levels,
costs, performance, dispute
resolution, etc.
Public
Pharmacies
Private
Pharmacies
Responsibilities




Meet service levels as negotiated in service contract with NIPDEC and merchants;
Provides timely service to client, as defined in service contract;
Maintain positive relationships with NIPDEC and merchant clients;
Provides regular service reports to NIPDEC;
CDAP Smart Card Solution: Governance Framework
15
CDAP Programme Delivery Partners
Through Memoranda of Understanding (MOUs), the Ministry of Health
will establish the roles and responsibilities for all programme
partners, i.e., the Regional Health Authorities, the Pharmacy Board
and the Medical Board that will define their role and responsibility in
support of CDAP administration and delivery.
CDAP Programme Delivery Partners
Provide strategic advice and guidance to the Ministry of Health, and participate in
the Steering Committee. Work with NIPDEC at the operational level to meet the
mandate of providing drugs to eligible patients, while staying within medical and
ethical guidelines.
Who’s Involved

Accountability Relationships
Representatives from the Regional
Health Authorities, the Medical
Board and the Pharmacy Board.
CDAP Steering Committee
Authority

Put forward for consideration and
approval disease and drug expansions.

Act as medium with its member
constituency to provide feedback on
the efficiency of the smart card
solution;

Put forward for consideration
recommendations on programme and
IT solution policies;
RHA
Pharmacy
Board
Medical
Board
Responsibilities

Provide advisory services on ethical and medical impacts and effects of the CDAP
programme and smart card solution;

Participate on the CDAP Steering Committee

Provide unbiased advisory services and support to the Ministry of Health and the
Steering Committee;

Provide feedback on the programme from the patients to the decision makers at
the Steering Committee level;

Provide feedback and input from their peers and colleagues to the delivery agent;

Provide input on the level of performance of the delivery agent;
CDAP Smart Card Solution: Governance Framework
16
4.0 Summary and Next Steps
The preceding discussion recommends specific governance
mechanisms to assign authority, accountability, and responsibility for
the CDAP Programme and the introduction and operation of the CDAP
Smart Card Solution. Implementing this new structure will require
additional efforts to fully define each organisational entity contained
within the framework and to establish the requisite accountability
mechanisms between them, e.g., Memoranda of Understanding, new
contracts, and Service Level Agreements. In addition, the following
are immediate tasks which are to be undertaken to support the
smooth rollout of the smart card solution:
Responsible Body
Task
Ministry of Health
Obtain Minister of Health and Cabinet
approval of redefined CDAP governance
framework
Create and define the terms of references
for the CDAP Steering Committee
Terms of reference would cover, but not be
limited to the following:
o Purpose of committee, mandate
and authority;
o Committee size and composition
o Member selection process
o Meeting frequency and quorum
o Roles and responsibilities
o Secretariat support
o Decision making process
o Conflict of interest
o Dispute resolution
o Reporting
Review and update the service contract
between the Ministry of Health and NIPDEC;
Create Memoranda of Understanding to
CDAP Smart Card Solution: Governance Framework
17
Responsible Body
Task
govern the relationships between the
Ministry of Health and the Pharmacy Board,
and the Medical Board;
CDAP Steering
Committee
Define Service Level Agreement (SLA) for
NIPDEC from the Ministry of Health;
SLA would cover, but not be limited to the
following:











NIPDEC
Statement of intent - Services to be
delivered
Performance Metrics, Tracking,
Reviews and Reporting
Service Availability Schedules
Compensation and financial
obligations
Problem Management and Support
Options
Warranties and Remedies
Legal Compliance and Resolution of
Disputes
Customer Duties and Responsibilities
Security
Intellectual Property Rights and
Confidential Information
Termination
Create Memoranda of Understanding
between NIPDEC and the Regional Health
Authorities
Create Memoranda of Understanding
between NIPDEC and the Pharmacy Board
and the Medical Board
Revise the contract between the individual
pharmacies and NIPDEC that will reflect
new operating environment
Revise the agreement between the
physicians and NIPDEC
Define, negotiate and execute Service
CDAP Smart Card Solution: Governance Framework
18
Responsible Body
Task
Level Agreements for the IT Solution
Provider, the Data Entry entity, the Card
Management firm, and TTPost.
Define, negotiate and execute SLA (service
contract) for the back-end, the terminal
solution space, and the smart card lifecycle
management for the IT Solution Provider
Develop communications plan / key
messages in support of governance rollout
and transition
IT Solution Provider
Define agreements with private pharmacy
merchants for terminals
Define agreements with RHAs for public
pharmacies for terminals
CDAP Smart Card Solution: Governance Framework
19