Modernising a decrepit health sector

By Eulalee Thompson

The large, complex health ministry has been plagued by numerous problems - growing customer dissatisfaction, perennial breakdown in equipment, shortages of drugs and other supplies and inadequate cadre of personnel.

A five-member Health Sector Task Force appointed by the health minister produced, in 2007, a 217-page report on modernising Jamaica's health care and implementing best practices as the country moves through the 21st century. This report was produced after numerous and extensive interviews and focus group discussions with stakeholders.

Dr Winston Davidson, chairperson of the task force said recently, in an interview, that the report was never tabled in Parliament as was the original intention. A copy of the document is, however, available on the website of the Medical Association of Jamaica for public perusal.

The recommendations

Several recommendations were made by the task force. Some of the main ones are:

1. The regional health authorities must be changed from semi-autonomous authorities to become regional coordinating and enabling organisations. In so doing, each will be an integral part of the organisation and structure of the ministry and a strong link between head office and the parish, enabling and supporting the function of implementation - which is the domain of the parishes.

2. Head office of Ministry of Health and Environment should focus on its primary role of policy formulation, policy determination, setting norms and standards, monitoring and maintaining support functions for strategic health care delivery.

3. Maintain the four health regions within the current borders.

4. Reorganise service delivery on the core functions of primary, secondary and tertiary health care.

5. Redefine the role of the parish manager to become the leader of the administrative support team and system, facilitating, enabling and supporting the efficient implementation of health-service delivery at the parish level.

6. Re-establish the corporate structure of all hospitals, with each hospital governed by a board of management and not a health committee of the region or parish. The reporting relationship to the board is to be the triumvirate of the executive manager, the senior medical officer and the director of nursing services. This must become part of a national standardised corporate structure which becomes part of the prerequisite for public-private partnerships and other community alliances, including international recognition and accreditation.

7. The National Health Fund (NHF) should be the executing agency for the immediate, short-term, medium-term and long-term information technology needs of the Ministry of Health and Environment.

8. The backlog of HR issues, including appointments, promotions, salary packages, welfare and incentive schemes, must be immediately addressed by a special multidisciplinary group in order to improve staff morale.

9. A National Human Resource Development Strategic Plan should be implemented as a matter of priority and that this be guided by epidemiologic principles.

10. The Health Corporation Ltd (HCL) should be transferred to the NHF as a department and be fully integrated into the NHF procurement system.

11. Policies must be developed for the standardisation of all categories of equipment, especially with regard to energy conservation and the replacement of parts.

12. Abolition of user fees for primary health care in every community as the first step to fulfil the commitment of the Government, but ability to pay should inform cost sharing of secondary and tertiary care.

Abolition of user fees

Davidson, who is also professor of public health at the University of Technology, when asked during the interview to expand on recommendation number 12, the contentious issue of user fees, placed the issue in a historical perspective.

"The removal of user fees occurred under the Michael Manley administration and there is no documentation that there has been a change there. When the IMF came in, the user-fee policy was put in by the Jamaica Labour Party, which was never changed by the People's National Party," he explained.

He further pointed out that in 1978, the Government of Jamaica signed an international document in Alma Ata which declared universal access to primary health care for all Jamaicans by 2000.

"2000 has passed and the evaluation showed that there is still a gap in primary health care. In 2006 to 2007 we were talking about free health care for all in primary health care. The prime minister at the time, Portia Simpson Miller, was looking at what she could afford and she indicated that the country should start with (free health care) up to 18 years old, and she got funding for this," he explained.

He said also that the plan is to focus on child and adolescent health care and to have a children's hospital in the western part of the island in addition to the Bustamante Hospital for Children located in St Andrew.

"That policy is still an integral part of the policy initiative to date although some aspects of the the policy has been reversed because the University Hospital which has paediatric facilities now charges a fee with the result that there is an overload on the Bustamante Hospital because of the health-seeking behaviours of patients who cannot afford to pay," Davidson said. " Now in my view, the range and diversity of the paediatric cases for clinical and teaching purposes will be compromised if the University Hospital continue to charge a fee."

Hints of a focus of free health care up to the Primary Health Care level (that is at the 375 health centres around the island) and for those who can afford to pay, to pay at the more expensive Secondary Health Care level (that is, at the more than 21 hospitals around the island) have been coming out of the new government. Health Minister Fenton Ferguson was also quoted in The Sunday Gleaner saying that:

"The question of health reform is definitely on the agenda, especially as it relates to regional health authorities. The fact is that we are spending over 77 cents per dollar to deal with compensation within these authorities."

Eulalee Thompson is health editor and a professional counsellor; email: eulalee.thompson@gleanerjm.com.