Editorial | Healthcare and oversight

The bickering between the Government and the Opposition over the state of Jamaica’s healthcare system exposes the failure of one parliamentary oversight committee as well as the folly of Prime Minister Andrew Holness’ decision to place the control of most of them in the hands of Government members.

As many people feared, control of the committees by ruling party members of parliament has lessened enthusiasm for matters potentially embarrassing to the government. Which probably explains why the Human Resources and Development Committee, chaired by Heroy Clarke, appears to have gone AWOL. It hasn’t met in 19 months, since November 22, 2022.

If Mr Clarke and his committee were serious about their oversight responsibilities, they would have found a way to open hearings into the health sector, even before the current political firestorm.

It has conducted no review of the island’s handling of the COVID-19 pandemic, which infected over 156,000 Jamaicans and killed nearly 4,000. Yet, there were many parliamentary statements and reports on the crisis by the health minister, Christopher Tufton, and other government officials.

Further, even if Mr Clarke missed the import of Dr Tufton’s May announcement of a planned reform of the primary healthcare sector – anchored around a five-year, J$2.5-billion programme to train hundreds of health professionals – a thoughtful chairman, who is serious about his oversight obligations, would have been concerned about the data in the state-of-health document, tabled at the same time. It showed an alarming rise in maternal mortality rates.

Mr Clarke’s committee should have wanted to get to the bottom of that matter, including what the figures meant for Jamaica’s adherence to the United Nations Sustainable Development Goals with respect to maternal healthcare, and whether the spike was merely a phenomenon of the COVID-19 crisis.

CONTROVERSY SIMMERED

With respect to the trigger of The Gleaner’s observations, a controversy has simmered between the Government and the Opposition over the quality of the care Jamaicans receive at public hospitals and clinics, as well as the broader management of the system.

Initially, much of the focus was on Cornwall Regional Hospital (CRH) in Montego Bay. What began seven years ago as a J$2-billion project to clean mould and replace CRH’s heating, ventilation and cooling system has morphed to an almost rebuild of the facility, with a projected cost to taxpayers of over J$21 billion. Some of that money, officials say, has gone to upgrading other hospitals and converting adjacent structures to accommodate some of Cornwall’s patients and facilities. Then there was the issue, first highlighted by the Auditor General, Pamela Monroe Ellis, in her 2022 report, of the health ministry’s failure, over nine years, to provide appropriations accounts for nearly J$700 billion worth of expenditure.

While this is not a problem peculiar to the health ministry, its officials are likely to have forfeited any sympathetic public hearing of their explanation that the failure was largely the result of a shortage of professional accounting staff, because of their permanent secretary Dunstan Bryan’s aggressive attempt to repudiate Ms Monroe Ellis’ criticism of the ministry’s use of purchase orders as formal procurement contracts during the COVID-19 emergency.

More recently, the opposition People’s National Party (PNP), through its shadow health minister, Alfred Dawes, a medical doctor, has latched on to the maternal death statistic, which at 156.7 per 100,000 in 2022 was twice as high as at the start of this century.

PROBLEMS IN HEALTHCARE

Dr Dawes, and other PNP officials, linked the spike in the maternal mortality rate to problems in the healthcare system, including a shortage of ventilators and insufficient intensive care units. They have been helped in their criticisms of two recent heart-wrenching stories of deaths because of a shortage of equipment and/or nonchalance of hospital staff.

In one, a young mother told The Gleaner how the staff at May Pen Hospital tried in vain to manually keep her premature baby alive because there was no working ventilator. Ventilators at other hospitals were either fully utilised or were too far away to make a difference.

Then there was the viral video of a woman giving the travails of having to transport her mother, who apparently suffered a brain aneurysm, from a hospital in Falmouth, Trelawny, to a private facility in Montego Bay for brain scans. The Falmouth facility lacked the appropriate machine as well as prescribed drugs.

The daughter clearly felt that in addition to the hospital’s lack of equipment and her family’s need to scour the island late at night to find drugs, her mother’s death, shortly after being admitted to a ward, was contributed by an almost callous indifference of staff.

Prime Minister Andrew Holness requested a full review of these incidents.

However, Dr Tufton says that the opposition is engaged in a “carpet bombing” of the health system as part of its campaign for the general election due next year. Noticeably, the Jamaica Civil Service Association, the public sector union, and Permanent Secretaries’ Board, a consultative body for permanent secretaries, have ring-fenced Dr Bryan.

There is no doubt, there is credibility to some of what Dr Tufton perceives as the opposition’s motivation. But it is also true that the healthcare system has substantial challenges, notwithstanding gains the minister says has been achieved over the eight years of this administration and his stewardship.

There are always legitimate policy differences and management approaches between governments and opposition parties on a wide range of issues, including healthcare. These are worthy of debate.

But part of Parliament’s responsibility is to provide oversight of the executive. When Prime Minister Holness changed the arrangement of parliamentary committees being led by opposition members, he claimed the move would enhance this process. Mr Heroy Clarke is proving this to the contrary.