Canute S. Thompson | Appraising Chris Tufton’s performance

Christopher Tufton has been the minister of health since 2016 (in 2019, ‘wellness’ was added to the ministry’s name). Like others, I am of the view that in terms of media analysis and critique of his performance, Tufton (who is an amiable gentleman) has been given a free pass. If the things that happened under his watch had occurred under Fenton Ferguson or Horace Dalley, the media would be on fire.

Notwithstanding, let us take a dispassionate look at his performance as we head towards the next general election.

The overarching goal of the Jamaica Labour Party (JLP) in respect of health and wellness, as outlined in its 2016 manifesto, was “universal access to effective and efficient healthcare for all Jamaicans”.

The menu of actions which were intended to get there include:

(a) Building a hospital in Portmore

(b) Expansion of Bustamante Hospital for Children.

(c) Upgrading of clinics.

(d) More health sector jobs.

Except for items (a) and (b), no specific targets were set, but definitively, neither of these have been achieved. It is arguable that the building of a children’s hospital in western Jamaica is a fulfilment of (b), but that project was already agreed between the previous People’s National Party (PNP) administration and the Chinese. So, at best, it may be said that he followed through, which is a good thing, and was big enough to give credit to others.

In relation to facility upgrades, a Jamaica Information Service February 5, 2019 report notes that “billions” had been spent upgrading health facilities. The report lists eight facilities that had either been upgraded or are in the process of being upgraded, the largest being the cancer treatment centre at St. Joseph’s Hospital, which had seen an investment of $860 million.

An April 5, 2019 report carried in the Jamaica Observer stated that five hospitals and 10 clinics would be upgraded. This would be financed through loans from the Inter-American Development Bank (IDB).

Considering these outcomes and plans, and despite the absence of specific targets, it is fair to say much work has been done.

HARD TO TRACK

On the issue of the creation of jobs in the health sector, I have not seen any set of data which report on jobs created in the health sector. Health sector jobs are not reported as a category by the Planning Institute of Jamaica (PIOJ), and so it is hard to track performance in that area.

A 2018 IDB study, titled The Future of Work in Latin America and the Caribbean , notes that the Jamaican health sector will need 12,000 doctors and 37,000 nurses by 2040. Given this estimate, it would be useful if the PIOJ begins to track employment in that sector. As of now, however, there is no way of objectively measuring the Government’s performance.

Public reporting indicates that there are major staff shortages of nurses as well as critical, specialised professionals. There are reports of vector-control workers being employed as well as a records management support staff, but some of these are short-term jobs.

I remarked to students in a recent class, during a discussion on policy evaluation, that the fundamental reason performance targets must be set when policy is made is that it is the only way to eliminate subjectivity in the evaluation process. I added that very often when politicians shy away from the outcome-determination process it is because they want to create an escape route, for in the absence of targets it is impossible to objectively measure performance.

CRISIS MANAGEMENT

The area in which performance in the health sector has been most problematic is crisis management. Three areas stand out, namely:

(a) Overall service quality.

(b) The Cornwall Regional Hospital carcinogens report.

(c) The management of the outbreak of dengue.

In relation to (a), there are countless stories of how under-resourced our health facilities are, particularly hospitals. Dr Edward Nigma’s (not sure if it is his real name) letter to The Gleaner, published on July 13, 2017, reads in part:

“The state of Jamaica’s healthcare is a problem that is being covered with a Band-Aid, when it is a festering wound that needs proper attention. As a medical doctor at the Kingston Public Hospital (KPH), one of the nation’s largest public hospitals, we are faced with examining and treating patients in areas with minimal or no lighting in suboptimal conditions…Patients’ beds don’t function: most beds cannot be wound up, and so patients who cannot lie flat have to have their beds propped up on cardboard boxes. Lights at patient’s beds do not work, and most of the ceiling lights are blown. Therefore, patients are being treated in low-light conditions…”

An October 7, 2019 story carried in the South Florida Caribbean News, titled ‘Healthcare in Crisis: Jamaica’s cry for a better health care system’, states in the penultimate paragraph:

“Jamaicans living in rural areas are already facing the issue of finding transportation to get to the doctor but to add to that, in order to receive certain treatments, the patients need to buy their own medical supplies.”

A colleague told me she visited the University Hospital recently, getting there at about 6 p.m. on the Friday evening.

She needed to have some tests done via the Accident and Emergency (A&E) Department. She spent the entire night waiting and did not get through until 4 a.m. the next day. There are countless stories of patients waiting in A&E, and A&E becoming a makeshift ward. Who will forget the several arguments between the health minister and various health practitioners?

Thus, while the upgrading of health facilities fulfils one promise and duly earns marks, the troubling reality is that the quality of health service is generally poor; and this is not the fault of health workers. There are systemic weaknesses, admittedly going back over several decades, which the current administration has not fixed.

In relation to (b) and (c), the fact that staff and the public were left in the dark about carcinogens at Cornwall Regional Hospital for over a year raises major legal and moral questions for the minister and the Cabinet.

The management of the dengue outbreak is a good example of how not to manage a national crisis. The Government has sought to place the blame on citizens, though there are pools of mosquito-infested water on government properties, including roadside (in low-lying parishes). Vehicles to be used in fogging were procured very late, and medical doctors have lamented the overall management of the crisis.

I give Tufton a C- for results and A for PR.

Canute S. Thompson, PhD, CMC, is head of the Caribbean Centre for Educational Planning; lecturer in educational policy, planning, and leadership; chair of the business development committee; and co-founder and chief consultant at The Caribbean Leadership Re-Imagination Initiative, at The University of the West Indies, Mona. Email feedback to columns@gleanerjm.com.