Editorial | Focusing on primary care

The fine print is yet to be unveiled. However, Christopher Tufton’s promised reset of Jamaica’s primary healthcare system, and an allied J$2.5-billion initiative to train additional medical staff, are, on their face, worthy undertakings.

However, while we celebrate these initiatives, Dr Tufton, the health minister, should cause his technical staff to engage in a public conversation on data he released this week showing a worryingly sharp rise in Jamaica’s maternal mortality rate, and whether there is likely to be a sustained rebate of these deaths in the post-COVID-19 period.

First, though, Minister Tufton could hardly have found a more deserving person for whom to name the memorial scholarships than Dr Barry Wint, the public health physician and chief medical officer (CMO), who died 18 years ago, aged 58. It is notable that nearly two decades after his death, Dr Wint is still well remembered not only for skills as a public health doctor and administrator, but also for the humility with which he served Jamaica and the Caribbean, as well as his innate decency.

The people who receive these scholarships over the next five years will have a significant legacy for inspiration. That primary healthcare will be among the beneficiaries is, for this newspaper, important.

Indeed, The Gleaner has in the past expressed its concern that despite the lip service paid to primary health, that element of the system has lost most of the swag it enjoyed a half a century ago when it played a crucial role in delivering health services to ordinary Jamaicans – and in improving their health profiles.

People, it seems, now prefer shiny buildings with humming diagnostic machines, even if they are insufficient and aren’t properly maintained. Policymakers enjoy the pretence of being able to deliver.

Which is not to suggest that there is no need for, or that Jamaica shouldn’t have, health services systems higher up the treatment chain. Rather, the issue is about how to most efficiently allocate limited resources and, as Dr Tufton explained, helping people to take responsibility for their health, while placing less pressure on those segments of the health service that are more expensive to deliver.

FEEL COMFORTABLE

It is important in that context for patients to feel comfortable and well served when they use the public health facilities, such as clinics, in their communities. Which is why we look forward to the rollout of what Dr Tufton told Parliament will be a “new primary healthcare model to facilitate more interventions for healthier lifestyles and disease prevention and more treatment services”.

“We will add more doctors, nurses and other categories of healthcare professionals as outlined in our new primary healthcare model,” the minister said. “We will begin the process of rolling out three new categories of health centres.”

Based on government data, Jamaica has around 0.7 doctors (including dentists) for each 1,000 residents, which significantly lags its key regional peers as well as the global average of just over two doctors per 1,000. The global figure is, however, heavily skewed in favour of developed countries. The island has around 1.7 nurses for each 1,000 inhabitants, less than half of the global average of 4.9.

The World Health Organization (WHO) estimates that countries need at least 2.5 medical staff (doctors and nurses) per 1,000 population to be able to deliver decent basic healthcare. However, Dr Tufton complained that Jamaica suffers from aggressive recruiting by developed countries that have shortages of doctors and nurses and can afford to pay better.

“We have to do more to train and retain, including accepting that we also train for export, and this will have to include collaboration with external partners, including institutions outside of Jamaica,” he said while updating Parliament on the performance of his ministry.

The Wint scholarships, on which the Government expects to spend J$500 million a year over five years to train a wide category of healthcare professionals, are part of this strategy, as is, the minister said, the government’s willingness to entertain flexible employment contracts with some seasoned professionals. That scheme would allow doctors and nurses to work, say, part of the year abroad and part in Jamaica.

The idea is worth exploring, especially given today’s flexible and mobile labour markets. We would add, too, the possibility of telecommuting medicine, as the need for the government to fix two big drivers of Jamaican immigration: weak economic growth and high levels of crime.

Meanwhile, this newspaper is concerned that Jamaica’s maternal mortality rate for 2022, though nearly 26 per cent lower than the previous year, was 156.7 per 100,000 live births, nearly twice the level at the start of this century.

Government figures show that pregnant and postpartum women with COVID-19 accounted for major slices of maternal mortalities in 2020 and 2021.

However, there is a need for deep analysis, especially in the face of up-and-down movement in maternal mortality rates over the past 14 years, and the clear question raised of whether Jamaica will meet its UN development goal of bringing the maternal mortality rate to below 70 by 2030.