Too many times the pub­lic sees a full dis­play of an ail­ing health­care sys­tem. How­ev­er, the cry of poor ser­vice on­ly comes af­ter an un­for­tu­nate death at one of our ma­jor hos­pi­tals, for ex­am­ple what took place with the ma­ter­nal death of Crys­tal Boodoo- Ram­soomair. With the Health Sec­tor Re­form Pro­gramme and the es­tab­lish­ment of the Re­gion­al Health Au­thor­i­ties in Ju­ly 1994, it was ex­pect­ed that the qual­i­ty of health­care de­liv­ery would im­prove. Un­for­tu­nate­ly, how­ev­er, the ail­ing sys­tem con­tin­ues to wors­en. In fact, pa­tients con­tin­ue to have long wait­ing times for most sur­gi­cal pro­ce­dures and med­ical spe­cial­i­ties be­cause of lim­it­ed op­er­at­ing time, in­ad­e­quate spe­cial­ists to man­age the large pa­tient load at pub­lic in­sti­tu­tions, and in­ad­e­quate avail­able re­sources at in­sti­tu­tions to fa­cil­i­tate ef­fi­cient health­care de­liv­ery. Dr Steve Bud­hooram, Head of Surgery, wrote on March 27: "Imag­ine wait­ing six weeks for a CT (com­put­er-as­sist­ed to­mog­ra­phy scan) and MRI (mag­net­ic res­o­nance imag­ing) re­port long af­ter the pa­tient has been op­er­at­ed on. What a fi­nan­cial waste."

We can­not plan to build more hos­pi­tals when all the ma­jor hos­pi­tals (Er­ic Williams Med­ical Sci­ences Com­plex (EWM­SC), Port-of-Spain Gen­er­al and San Fer­nan­do Gen­er­al) are in a state of dis­re­pair and where there is a short­age of all ma­jor cat­e­gories of staff, in­clud­ing nurs­es, doc­tors, phar­ma­cists and al­lied health pro­fes­sion­als. The con­tin­u­ing fail­ing health sec­tor in most as­pects is due to chal­lenges faced in at­tract­ing and re­tain­ing the right hu­man re­sources, not just clin­i­cal but al­so the ad­min­is­tra­tive per­son­nel, who are the life blood in this sec­tor. The com­pen­sa­tion pack­age needs to be re­viewed in light of mar­ket rates. Terms and length of con­tracts must be re­viewed, as young pro­fes­sion­al are giv­en one-year con­tracts, re­sult­ing in lack of com­mit­ment. It is not ad­vis­able to con­struct a 220-bed hos­pi­tal in Ch­agua­nas when EWM­SC is un­der-utilised and poor­ly man­aged. Let's re­move the pol­i­tics from the health­care sys­tem and do what is best for the coun­try. It is true that Ch­agua­nas re­quires a prop­er health fa­cil­i­ty, but not a hos­pi­tal. While it is good po­lit­i­cal­ly to build new hos­pi­tals, the way to go should be to con­cen­trate on en­hanc­ing, re­fur­bish­ing and even build­ing/re­plac­ing the ex­ist­ing rub­ble of hos­pi­tals/build­ings at PoS Gen­er­al and San­do Gen­er­al, for ex­am­ple.

While it is agreed that there is a grow­ing pop­u­la­tion in Ch­agua­nas, in­stead of a hos­pi­tal con­sid­er­a­tion should be giv­en for an en­hanced dis­trict fa­cil­i­ty with the fo­cus be­ing on the EWM­SC in pro­vid­ing state-of-the-art equip­ment and staff to pro­vide that ser­vice. I think mon­ey would be bet- ter spent. To ex­pand the de­liv­ery of the health ser­vices by build­ing ad­di­tion­al in­sti­tu­tions with­out cor­rect­ing the present sys­tem will on­ly fur­ther add to the de­te­ri­o­ra­tion of the health­care de­liv­ery sys­tem. No longer can the pop­u­la­tion wait 12 months for an MRI, no longer must there be long wait­ing lists for re­nal dial­y­sis and on­col­o­gy ser­vices, or op­er­a­tions post­poned be­cause of a lack of blood, over­crowd­ing at the wards and long wait­ing times at Ac­ci­dent and Emer­gency. These de­fi­cien­cies must be suit­ably and ur­gent­ly ad­dressed.

There is a need to take a se­ri­ous look at the ap­point­ment of board mem­bers and the se­nior man­age­ment teams and their ca­pa­bil­i­ty to de­liv­er and then hold them ac­count­able for tax­pay­ers' mon­ey. The an­nu­al ser­vices agree­ment be­tween the Min­istry of Health and the Re­gion­al Health Au­thor­i­ties must be seen as a first step to ac­count­abil­i­ty by the RHAs. Each RHA spends ap­prox­i­mate­ly $1 bil­lion an­nu­al­ly. But is the pop­u­la­tion get­ting val­ue for mon­ey? There needs to be a greater ac­count­abil­i­ty and trans­paren­cy of the spend­ing of tax­pay­ers' mon­ey.

It is time for us to re­view health­care de­liv­ery in T&T. The present bud­get al­lo­ca­tion of ap­prox­i­mate­ly $4.1 bil­lion to the Min­istry of Health is in­ad­e­quate, which is less than four per cent of the GDP. There have al­so been con­cerns by both pa­tients and health pro­fes­sion­als about the qual­i­ty of gener­ic drugs bought for the CDAP pro­gramme. In fact, the use of poor qual­i­ty drugs in­creas­es the bur­den of hos­pi­tals and oth­er spe­cialised ser­vices. It is time for us to re­view the pro­cure­ment process in the pur­chas­ing of drugs for Nipdec and for the con­tin­u­ous mon­i­tor­ing of these drugs to de­ter­mine their ef­fi­cien­cy. The RHAs ob­tain drugs from Nipdec by way of a Min­istry of Health arrange­ment. This arrange­ment needs to be re­viewed in light of in­ter­na­tion­al stan­dards, as there is now a very ed­u­cat­ed pub­lic who de­mands this stan­dard. It is time that we de­vel­op a mas­ter plan for the de­liv­ery of health ser­vices in T&T with pri­ma­ry health­care play­ing a piv­otal role, since 60 per cent of our dis­eases are pre­ventable. That will as­sist in re­liev­ing the bur­den that now faces sec­ondary health­care. Pri­ma­ry health­care is in dire need of en­hance­ment and the nec­es­sary fund­ing and fo­cus should be put in place. And a mar­ket­ing plan should be de­vel­oped to pro­mote this ser­vice. There is much to done in the health ser­vices. Let us re-en­gi­neer the de­liv­ery of health ser­vices and set up an in­de­pen­dent Cab­i­net-ap­point­ed body to im­ple­ment some of the find­ings of the Gladys Gafoor Re­port on the op­er­a­tions and de­liv­ery of pub­lic health­care.

Dr Har­ry Singh

Coun­ty Med­ical Of­fi­cer of Health St George Cen­tral