Too little, too late
Now that the audits of the public-health system have been published, we can see why Health Minister Fenton Ferguson refused for so long to release them to the public.
As bad as we might have assumed the conditions in government hospitals to be after Dr Alfred Dawes blew the whistle, the health audits have revealed the situation to be much, much worse. Minister Ferguson was smart enough to know that once the audit reports became public, he could not have kept his job.
His best defence might be that all the problems in the health sector did not begin with him - and he would be right. The very first observation by the auditor of the conditions in the South East Regional Health Authority (SERHA) was: "Structurally, the operating theatre suites were built many years ago, and hence, the layout of the operating rooms, sluice rooms, recovery rooms, etc., are not ideal. ... e.g., at BHC (Bustamante Hospital for Children) sterile supplies and instruments have to be taken through the 'dirty' sluice room to get to an operating 'clean' area."
Fenton Ferguson did not design the layout at the BHC, and, therefore, he is not to blame for the daily and hourly contamination of sterile surgical instruments there. In the Western Regional Health Authority (WRHA), "the ICU is not in close proximity to the Accident and Emergency Services", and Fenton Ferguson cannot be blamed for inefficiencies there.
But Fenton Ferguson was appointed minister of health 34 months ago, yet it seems that he only came to grips with the realities on the ground with his portfolio last August when a whistleblower forced him to order the audits. His big deficiency as minister is that he presided over a failing health sector and apparently didn't know it; and when he became aware of it, he tried his best to cover it up.
Had he ordered the audits at the beginning of his tenure, he would have been in a position to craft a realistic strategic plan to properly manage his portfolio for quality health-care delivery.
Perusing the reports of the four regional health authorities convinced me that 40-50 per cent of their problems relate to inadequate funding, while 50-60 per cent relate to poor management. Sure, their budgets were small to begin with, and then were cut back even further; but good management would have reduced the wastage in the health-care system, and would have led to cost savings.
By cost savings, I am not referring to reusing disposable "tubes and airways" (SERHA), and reusing disposable "laryngeal masks, anaesthetic/ventilator circuits, suction tips and filters" (WRHA) after cleaning with chemicals that will "disrupt the surface of the plastic tubing and create pockets for organisms to attach and multiply" (SERHA). Most of the audits report weak inventory control (i.e., leakage of expensive supplies) and postponing essential preventative maintenance of equipment, which leads to greater replacement expense in the end.
It was the Jamaica Labour Party (JLP) government that implemented a crass regime of no user fees, which has compounded an underfunded and under-resourced health-care system. Therefore, the JLP has to assume some of the responsibility for the present debacle. I believe that health care for the poor and destitute should be free or nearly free; but people who can afford to pay should pay something; and the middle class should not get free health care.
I blame Minister Ferguson for mindlessly continuing the JLP's crass regime when he could have put a better system in place that protected the vulnerable while collecting from those, who could afford to pay. Things are bad, but good management could have made things better.
If Minister Ferguson had been in touch with what was happening in the public clinics and hospitals across the island, he would have realised that the present arrangements were unsustainable. He should have known that urgent action was required to stem the rot and prevent a disaster. Some kind of national health insurance programme is needed, homologous to the National Insurance Scheme (NIS), to fund health care for those who need it and cannot afford to pay. But Minister Ferguson did nothing in this area.
Part of the problem is that Jamaica's public-health system was not designed for use by the middle class, who use private hospitals or travel overseas. Senior civil servants and government ministers have health-care arrangements in their contracts, which provide for overseas health care. The audit of the conditions in the regional health authorities reveals a callousness towards the poor that belies the claim that the government 'loves the poor'.
Yes, the buck ultimately stops with the minister of health, and he must man up to his responsibilities. But he operates at the policy level; day-to-day operations are the responsibility of the permanent secretary and other ministry staff; and the boards of management of the regional health authorities are responsible for conditions in their regions. To their credit, when called upon to perform the audits, the regional health authorities (for the most part) did a creditable job, with the possible exception of the Southern Regional Health Authority. Why could they not have done similar audits at the time they were appointed, to understand the status quo in their region?
How embarrassing it must be for the chairmen of the four regional health authorities to have issued a statement of full and comprehensive support for Minister Ferguson who appointed them, only to see the prime minister relieve him of his post! They have lost any credibility they might have had. Their own audits expose their incompetence and non-performance, and the actions of the prime minister constitute a vote of no confidence in their judgement. But then, maybe they did not expect the report of their audits to become public knowledge. I expect to soon hear that those political appointees have tendered their resignations.
Either the permanent secretary of the Ministry of Health and the chief medical officer did not read the four audit reports (which would be dereliction of duty), or they have chosen to join the cover-up. In the interest of good governance, either they should resign, or the new minister of health, Horace Dalley, should demand their resignation.
This Cabinet reshuffle is too little, too late, and clearly is largely cosmetic. By all accounts, we are on the cusp of an election, and the new appointee minister can hardly be expected to make any serious changes in the quality of health-care delivery in so short a time. The question is whether the prime minister's new-found decisiveness in this minor Cabinet reshuffle will be interpreted as political opportunism, or a belated awakening of a dormant sense of accountability.
- Peter Espeut is a sociologist and development scientist. Email feedback to firstname.lastname@example.org.