Move quickly on healthcare reforms

In the 2012 budget, Parliament approved the allocation of $3.8 billion to the Ministry of Health. This means that the administrative arm of the Government responsible for taking care of the healthcare needs of the population was the fourth largest recipient of money from the Consolidated Fund—following the Ministry of Finance, charges on the account of the public debt and the Ministry of Education. 

With billions of dollars being spent every year on the provision of state-funded healthcare, there is a sense in which the Ministry of Health supervises a sector that is standing still or one which is heading back to the future. What other explanation can be found for this week’s reports that patients at the San Fernando General Hospital were forced to sleep on benches or chairs, or the disquiet of the current Minister of Health, Dr Fuad Khan, over the often self-serving relationship between doctors in the public and private sectors?

Someone picking up a newspaper from 20 or even 40 years ago would have seen reports of the exact same problems, which have recurred periodically over the years. Shortages of beds and drugs, long waiting periods and conflicts between private practices and public-sector work have now become perennial problems, deeply embedded in the psyche of generations of patients and seemingly immune from incremental change, far less substantive transformation. 

The impatience of Dr Khan, himself an outstanding specialist physician, with events in the public health sector is understandable. It’s an impatience shared by thousands of members of the public who have been short-changed by the deficiencies in the provision of public healthcare.

The most noteworthy development in health in the last two decades has been the division of the country into five regional health authorities 18 years ago—a move meant to decentralise the provision of healthcare and make it more responsive to the needs of individual regions and hospitals.

By and large, the establishment of the RHAs has been a failure, as there has been no discernible improvement in the speed or efficiency of service to the public, while the quality of that service remains very much a question of luck. Deprived of the economies of scale of the previous system, the RHA bureaucracy, which no doubt was meant to create accountability, has had the opposite effect, as officials pass the buck, and routine and recurrent issues are not dealt with and eventually become crises that successive ministers have had to personally step in to address.

Having an insider’s knowledge of the system and many of its personalities, Dr Khan has not hesitated to upbraid his former colleagues, who he feels are taking advantage of a broken system to feather their own nests. Such an approach may work for a consultant dealing with an errant junior doctor, but may not be ideal in terms of bringing staff onside to bring about the necessary changes.

And there are few who would argue that the provision of healthcare in T&T needs to be brought into the 21st century. To achieve this, Dr Khan should marry his anxiety to change the system with a structured approach aimed at ensuring that the change that occurs is sustainable, affordable and consensual. The first step to change must be in identifying the problems of the current system.
 

But Dr Khan must eschew the commission of enquiry approach, which has proven to be very expensive, time-consuming and almost guaranteed to ensure that the recommendations are shoved onto a shelf to collect dust—as has been the experience with past enquiries into the health system.

Instead, three experts in healthcare reform should be chosen and mandated to report within a short time period after having interviewed all of the main players in the system. If the change that is required means dismantling the RHA system and replacing it with something more streamlined, then the minister must be prepared to place the patients at the centre of his policies and bring them some relief.