Let sting squads target hospitals
One of the weaknesses that emerged from the dead-babies scandal was the poor communication between the regional health authorities and the Ministry of Health. Not surprisingly, written or verbal correspondence is the predominant means of conveyance of critical information currently.
However, in health care, the challenges experienced by patients and workers need to be seen and/or experienced in order to be fully appreciated. For example, a report stating that "operating theatres remain heavily under-resourced" cannot convey the required sense of urgency as effectively as witnessing first-hand a surgeon dressed in a garbage bag and operating in a theatre that is both dimly lit and colonised by fungus.
Since it is ultimately the minister who is accountable, I make the following pragmatic recommendations to him and his technocrats in an effort to augment the information reported by the regions.
One: Initiate frequent unexpected, unscheduled visits to public health-care facilities.
Recently, an unscheduled visit by Tanzanian President John Magufuli to the Muhimbili National Hospital revealed patients sleeping on the floor and diagnostic machines in disrepair. Shocked by what he saw, he sacked the health minister and entire hospital board and revamped the ministry.
Local ministry officials must develop the practice of frequently leaving their offices to pay random, unscheduled, unannounced visits to public health facilities. For example, if the minister shows up unexpected and unannounced to a particular unit of a public hospital with a request that the nurse or physician in charge accompany him on an immediate walk-through, an uncensored and authentic picture of the prevailing realities there will be obtained.
This is because, with no advance notice, there would be no time for the usual artificial role play, posturing and window dressing by the staff which accompanies a scheduled trip, and which serves no useful purpose other than to distort the realities.
Additionally, the mere knowledge that a surprise visit from a senior ministry official may occur at any time is a powerful incentive for staff members and workers at these institutions to strive to adhere to best practices at all times.
Two: Use 'pretend patients' to provide ongoing quality surveillance.
In January 2015, Kimberley Hibbert of the Jamaica Observer, posing as a patient, entered the emergency rooms of the Kingston Public and Spanish Town hospitals, and wrote about her ordeal. In 2012, The Gleaner's Tyrone Reid (now of CVM) went undercover as a porter at the KPH, and subsequently published his shocking expose. The excellent investigative work by the two journalists exposed realities that sparked intense debate on the state of our public health-care system.
Though unorthodox, the methods highlighted the importance of conducting quality surveillance in secret at the point where it matters most - the point of contact of the patient with the health-care system.
The ministry should engage the services of 'pretend patients' who are mandated to enter public health-care facilities islandwide with feigned symptoms while discretely observing and documenting the patient experience from a first-hand perspective. Such persons could be either formally contracted to provide this service, or could be low- or middle-level ministry employees workers whose job descriptions require them to perform this function.
Since their job is only to observe and document, they can conveniently decline any invasive therapies and leave the unit once they have completed their assignment.
Obviously, such investigative work yields actionable results only if the local and regional hospital administrators are kept deliberately unaware of the operational details, including the timing and frequency of such visits and the identity of the individuals involved. Additionally, such persons should be able to relay their findings directly to senior personnel within the ministry, who have the power to investigate and to act to correct inadequacies unearthed.
Three: Establish channels for the anonymous reporting of observed deficiencies.
Health-care workers and members of the public frequently spot gross deficiencies in public health-care facilities but fail to report them because of a fear of victimisation, the absence of established reporting channels, and a belief that nothing will come of their efforts.
Such deterrents to reporting can be overcome by the ministry establishing a toll-free hotline and an email address, to which relevant evidence in the form of photos and video or audio recordings captured by anyone can be uploaded discretely and anonymously. Such reporting is especially effective if widely publicised and encouraged. In fact, its success is rendered easier by the fact that today, Internet-capable smartphones are virtually ubiquitous.
Imagine, for example, if there existed a such a virtual space to which the shocking photos presented by Dr Alfred Dawes months ago could be have been anonymously transmitted to the ministry. The graphic nature of the images would have prompted action. The subsequent embarrassing fallout could have been averted, and potentially 19 lives could have been saved.