Time to get it right in health

With the public-health sector being placed under the microscope, Dr Myrton Smith, president of the Medical Association of Jamaica (MAJ), last week issued that entity's take on the issue. Here is a lightly edited version of that release.

The dangers of reusing medical devices that were designed to be used only once (single-use devices or SUDs) has been a topic of discussion in recent days.

This is not a new concern and is one of the challenges that our doctors face while working in the public sector.

For several years, doctors have been demanding that successive governments take steps to provide adequate supplies of drugs, medical disposables and medical equipment.

Because we are conscious of the high standards to which we have been trained and the increasing expectations of our patients, we have also made several requests that the Government provides us with indemnity for our public practice.

This means that in the event that a patient comes to harm due to the inadequacies in the system, the Government would take the responsibility and not the doctor.

This responsibility should include providing legal representation and payment of any claims, especially as the private insurers would not cover us in those instances. This does not, in any way, absolve the doctor of any claims of negligence, as we still have our duty to care.

Jamaica is not the only country in which health-care practitioners have been forced to reuse single-use devices. In fact, the Food and Drug Administration in the United States and authorising bodies in several other developed countries have established guidelines for the reprocessing of SUDs.

These standards seek to ensure that they are properly cleaned and sterilised to avoid patient-patient transfer of fluids and infections. Steps must also be taken to ensure that the reused devices function properly, thus avoiding harm to patients.

Most of these guidelines establish that the hospital/health-care facility then takes on the role of the 'manufacturer' and is, therefore, held to the same high standards of all manufacturers.

The current discussion provides an incentive for the Government to conform to these standards.

The former president of the Jamaica Medical Doctors Association, Dr Alfred Dawes, spoke openly and passionately about some of the obstacles preventing the optimal delivery of health care.

LOOKING AT THE ISSUES

The responses to Dr Dawes' candid pronouncements highlight some of the problems with our country - truth and courage have become the exception rather than the norm.

This cannot be what our founding fathers expected when many of them laid down their lives to obtain our Emancipation and Independence.

It is time we take a critical look at some of the issues that he highlighted.

One truth is that politics should have no role in the administration and delivery of health care. It requires the input of persons who are truly committed to the process and not to their own political or other selfish ambitions.

Another fact is that the sector did not collapse overnight, but where we are now is the culmination of years of continual underfunding, short-sightedness and a lack of implementation of a cohesive long-term plan for developing the sector. It is time to place health as a national priority.

The MAJ has consistently stated that the no-user-fee policy has placed additional stress on the system, creating more problems than it was meant to solve.

This is not because it is a bad idea in principle, but because it was implemented without the requisite plans for sustainable financing. We agree that the most vulnerable in society should have continued affordable access to health care, ensured by an assessment process similar to that used for PATH.

However, the reality is that health-care delivery is expensive and someone has to pay for it. It involves much more than just paying the salary of the workers that are essential to providing the service.

It involves the provision of disposable medical supplies, diagnostic and therapeutic equipment and the building and maintenance of the physical infrastructure.

SOLVING FUNDING CRISIS

The solutions for financing may involve reintroduction of user fees for those who can pay, increased budgetary allocation and forging or strengthening partnerships between the public sector and the private sector.

Regardless of the measures taken, the service that is delivered must match the expectations of the users of the system.

Decentralisation of the health sector has been blamed by many as a major contributor to the deterioration of the sector by increasing the bureaucracy and making the system less responsive to the needs of the staff and patients.

Another accusation has been the increased focus on a management structure and reduced input from technical staff within the different health-care facilities, such as the senior medical officers and matrons/directors of nursing services.

The reporting relationship between the Ministry of Health and the regional health authorities was also revealed to be dysfunctional in the recent crisis, and this impacts negatively on the necessary accountability of the minister and his chief technocrats.

Certainly, this is an opportunity to look at the regional health authorities with a view to either increase their efficiency or devise a new system.

We also need to improve accountability by finding ways to ensure that there is oversight of the management of our scarce resources, and the MAJ will continue to lead the vigilance in this regard.

Such oversight must also involve our nurses and other health-care workers, members of civil society, members of the private sector, health economists, media practitioners and members of the general public.

We cannot continue to encourage a culture of silence. What the recent crises have shown is that the true power of democracy lies in the voice of the people.