The Health Authority of Anguilla (HAA) was established in 2004, transferring provision of services to a statutory authority, aiming to allow service managers to operate free of public service constraints.
The sector review concludes that the HAA is not independent enough. The government exerts unnecessary and partisan influence through the board of management. The review also finds the HAA is not incentivised enough. It receives government subvention regardless of its performance and, as a result, continues to behave as if it were still part of the civil service with few rewards or sanctions for staff related to their performance.
The report recommends making the HAA completely independent, earning income through performance. For this to work, public finance must be channelled through a competent technical funding body with the ability to ensure performance is achieved for the finance received by providers. The recommended structure for the HAA is a company with shares all owned by its staff but that cannot be traded.