Editorial | Don’t lose the doctors

If there is a class of professionals likely to be warmly welcomed by advanced economies at this time, it is physicians. These countries’ health systems, especially those of the United States and Britain, to which Jamaicans are wont to emigrate, are badly stressed by COVID-19.

We are, therefore, surprised at and concerned about the reported inability of Jamaica’s public-health system to employ doctors even in circumstances of clear need and after hospitals entered into agreements to hire the physicians, including, it appears, experienced specialists. Indeed, as this newspaper reported, some institutions, including the University Hospital of the West Indies, have been forced into the embarrassing position of rescinding employment offers after the doctors began working.

Our fear, in the circumstances, is that if the situation isn’t urgently resolved, there could be, the risks of the coronavirus pandemic notwithstanding, an accelerated migration of recently graduated doctors, joining the well-worn path of nurses, who regularly leave in droves for jobs abroad. That would not only complicate Jamaica’s capacity to respond to the potential dangers of the pandemic, but also to challenges being wrought by the island’s changing demographics.

Neither on the website of the health ministry nor that of the Medical Council of Jamaica, the body that maintains the registry of physicians, is there readily accessible data on the number of doctors in the island. Nor is there any such information in the 10-year strategic plan for healthcare delivery tabled in Parliament in 2019 by the Health and Wellness Minister, Dr Christopher Tufton.

However, other sources estimate that there are approximately 1.3 doctors to every 1,000 Jamaicans. In the United States, the ratio is 2.6, and in Britain, 2.8.

No one expects Jamaica, given its state of economic development and its fiscal constraints, to have First-World ratios of healthcare professionals or even that in the context of the global health crisis, there would be an overly aggressive policy of recruiting doctors. At least, not in the fashion proposed by the Government’s COVID-19 task force for community health aides and public health inspectors.

But that same task force recognises that if Jamaica’s economy is to function, as it must in the foreseeable future, with the presence of COVID-19, then its “public-health infrastructure will need to be enhanced to ensure that it can curtail the spread of the virus while also having the requisite capacity to handle the cases that will invariably occur”.

That, clearly, must mean having a sufficiency of doctors in the public-health system to help in the delivery of critical care perchance there is a serious outbreak of the virus – a risk that rises as Jamaica reopens its economy, including to foreign tourists. In this environment, Jamaica cannot afford to lose its existing doctors, including, as could now happen, the replacement cohort for those who will be lost through natural attrition.

Indeed, even before the COVID-19 pandemic, the issue of having a rational programme for ensuring an adequate number of skilled healthcare workers, at all levels of the system, was recognised by the Government. Several demographic and health factors have driven this awareness.

AGEING POPULATION

As Dr Tufton’s policy paper observes, the island’s population is becoming greyer. Currently, approximately 13 per cent of Jamaicans are 65 or older. In five years’ time, that age group will account for between 16 and 18 per cent of the population, raising new economic, social, and healthcare challenges for policymakers. It also happens that this age cohort is the most vulnerable to the COVID-19, requiring the most intensive and specialist care if they become ill with the virus. Further, up to a third of Jamaica’s population suffers from at least one chronic non-communicable disease such as diabetes and hypertension.

Even before these issues were complicated by the COVID-19 factor, Dr Tufton, in his policy paper, was lamenting his ministry’s “continuous struggle with the issue of insufficient numbers, deployment, and retention of key (healthcare) providers”. And that is without taking into account the fact that 12 per cent of the public healthcare staff was, in 2019, over the age of 55, including one per cent being older than 65.

“Based on this information, there needs to be greater integration of human-resource planning for health-services delivery, based on population needs, and considering the potential attrition (of staff) due to migration, retirement, and other causes,” says the policy document.

The Government ought not to worsen this problem by its own misadventure. We appreciate the worsened fiscal situation in which Jamaica finds itself because of the COVID-19 pandemic. But in a crisis such as this, existing orthodoxies have to be relaxed as the Government has done with the fiscal rules. Perhaps more is required. Or maybe someone didn’t get the memo regarding how critical it is, at this time, to maintain our health professionals.