Last update: 12-Dec-2013 4:50 am
Thursday, December 12, 2013
Trinidad & Tobago Guardian Online
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$400m from Health goes back to Consolidated Fund
The health sector continues to be plagued with a plethora of problems. Like crime, government after government has been grappling with a system that is in dire need of resuscitation. Last year, health received the third-largest allocation in the national budget. A total of $5,1108.7 million was allocated to health, while education and training received the largest chunk—$9,149.1 million.
But several delays have caused close to $400 million of last year’s allocation to go back to the Consolidated Fund (CF), since the construction of several hospitals had not started in the fiscal year in which the money was allocated. But funds simply cannot be moved over to cover other areas deemed critical. In fact, it is normal for funds to return to the CF if they have not been spent for the purposes intended.
Tomorrow, Finance Minister Larry Howai will deliver the fourth budget under the People’s Partnership Government. It will be his second budget presentation. Health Minister Dr Fuad Khan is the second person to be appointed the portfolio since the PP assumed office in May 2010. His predecessor Therese Baptiste-Cornelis was fired in the first Cabinet reshuffle in June 2011.
In his presentation last year, Howai said, “We are addressing the well-being of the citizens of this country through the expansion in healthcare delivery, as well as improving healthy lifestyles among our citizens.” Among some of the projects he listed were new hospitals in Point Fortin, Arima, Sangre Grande and Chaguanas, National Public Health Laboratory, Caribbean Public Health Agency at Caura and the upgrade of the San Fernando General Hospital.
Howai then said the Ministry of Health would fund these projects through public-private partnerships and joint ventures. He said the ministry was also at an advanced stage of pursuing such arrangements for oncology, cardiac surgery and organ transplants.
“Moreover, negotiations are at an advanced stage for establishing financing agreements for a hospital in Couva which will cater for children and adults and which would have a burns unit, a teaching hospital at Chancery Lane San Fernando and a National Centre for Non-Communicable Disease in Penal.” But despite all the plans and initiatives, many citizens continue to complain about the delivery of services.
Delays in project kicking off... so $$ goes back
On Friday, Khan said under recurrent expenditure, $95 million was going back to the CF and $168 million from a budget of $396 million from the Development Programme was also unspent. Additionally, close to $150 million under the Infrastructure Development Fund (IDF) was also not spent.
Khan said this was because of delays in projects kicking off. However, he said most of them were expected to be awarded and construction will begin in the upcoming fiscal year. He said, “What tends to happen is that once Parliament dictates this has to go a certain direction, the only way you could change that is you have to go back to Parliament, that’s why we have the Supplementary Appropriation Bill. “We cannot use the money for anything else.”
He said the money was specifically for construction of certain hospitals such as the Women’s Out-patient Clinic, San Fernando Enhanced Health Centre, the Sangre Grande Health Centre and several others. Khan said the recurrent expenditure was mainly for salaries.
He said money in the IDF could not be touched once the Parliament had made a decision and the budget was passed. “You cannot spin it around at all.”
He said if the money was not spent for what it was supposed to be used for then it had to go back to the fund. Khan said detractors may want to say he did not spend the money but it would be illegal for him to make a decision to use money elsewhere. “It is illegal and the Ministry of Finance will never allow us to move money like that,” he said.
So what exactly was the bulk of the money spent on?
Khan said the Chancery Lane project which is set to be opened by year-end, purchase of equipment, refurbishment of A&Es, health centres, improvement of a mortuary, Toco Health Centre, Mayaro Hospital and a new Blood Bank were some of the areas the money was spent. He said despite this, the complaints will not cease. A big chunk of money is also spent on tertiary-level services. He said the health centres and health offices will be opened later to take the load off the emergency section.
However, several doctors and nurses do not want to work late because of the poor salaries they are paid, Khan said.
Khan: Big deterrent is proper salaries
Doctors and nurses are not paid sufficiently, Khan said. He said the MPATT was trying to place a proposition to the CPO to increase the salaries of doctors and other personnel. The basic salary of doctors range from less than $20,000 to about $33,000 for consultants. This is before tax. Khan said this was low when compared to the international level. “This is low. I can’t even get a neurosurgeon to work because a neurosurgeon will make in one surgery three times that amount.”
Khan said getting more equipment meant getting more staff. “You have to pay radiographers, you have to pay radiologists, you have to pay escorts. “If they don’t want to work because they aren’t paid properly and you can’t get that volume of professionals to work, then you’re going to have a backlog.” He said human resource and salaries were major setbacks.
He claimed the Regional Health Authority Act had a proper remuneration scheme but it went “haywire” under another adminstration and it was placed in the hands of an inter-ministerial committee and the CPO. He said the CPO keeps salaries in structured ranges like in the Public Service but it ought not to be like that. “It supposed to be on need and shortages...supply and demand.”
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