Sun | Jan 20, 2019

Fixing health: Charting health care reform

Published:Wednesday | December 9, 2015 | 12:02 AMDr Alfred Dawes
Dr Alfred Dawes, immediate past president, Jamaica Medical Doctors Association.

The regrettable occurrences that have propelled the discussion on health-care reform to the forefront of the nation's conscience must not have been in vain. We as a country with ambitions of achieving first-world status cannot afford to not have a respectable health-care system.

Now that we have seen the ugly underbelly of the health-care system, we must accept that all is not well and take steps to address the fundamental reasons why we got to this state.

Health-care reform is needed. And needed now.

The new minister of health has indicated his intention to do so, and has already taken some steps in the right direction. However, much more is needed.

Any attempt at reform must seek to:

1. Create an efficient and responsive health-sector organisational structure.

2. Improve access to care.

3. Create sustainable health-services financing.

4. Improve patient satisfaction.

So far, we have taken a piecemeal approach to health-

care reform in Jamaica. Decentr-alisation was supposed to bring the decision-making process closer to the health-care workers and create a more efficient means of supplies distribution and loco-regional problem solving.

Needless to say, this has only resulted in another layer of bureaucracy that has created an accountability maze with a blame-loop where nobody is at fault for any problem encountered.

The semi-autonomous Regional Health Authority model has been an abject failure and faces similar criticisms in other countries such as the United Kingdom (UK), Trinidad and Tobago, and Guyana.




The no-user-fee policy was a botched attempt at creating universal access to health care. Without a dedicated source of financing, the universal access envisioned by the then Gover-nment led to a rapid deterioration of the quality of service received by patients.

Patients, staff and relatives have all been left worse off since its implementation.

To address the complaints of the patients, the previous minister focused on 'The Misery Index'and attempted to make patients more comfortable, and staff more accountable for poor treatment of patients. This was a good starting point, but missed the fundamental problems brought about by the weaknesses in the other three columns.

It is easy to find scholarly articles and reports outlining what should be done to achieve reform goals. However, what is lacking in the literature is how to carry out these reforms.

Whenever there is change, there will be resistance. This resistance can be passive-aggressive or be in the form of outright opposition and sabotage. Persons who stand to lose the most will often be most vocal in their opposition to the reform process. Various stakeholder groups must be courted and the political landscape of Jamaica taken into account when enacting the necessary sweeping reforms. Potential opposition can be converted to alliances.

The Regional Health Authorities in particular will see their powers cut significantly, akin to what occurred in the UK. Without a buy-in from the regions, there will be little chance of success. They have the power to derail any reform process easily and must have the desire to improve the system.

Professional bodies such as the Nurses Association of Jamaica, the Medical Association of Jamaica, and the Jamaica Medical Doctors Association continue to be very vocal about the need for fixing health.

These associations have members who are knowledgeable and experienced and have a vested interest the improvement of the sector. Any attempt at reform must include the input of these and other stakeholders. Their memberships will inevitably have to endure more sacrifices and it is important to get buy in from them, rather than force them to submit to new rules and governance structures.




It is difficult to imagine bipartisan support on any major issue affecting Jamaica. However, the political football we are playing with health will ultimately lead to the undoing of the support for either political party. They will never be forgiven if they cannot put country before selves and work together to achieve a better health sector.

The issue of healthcare financing is a particularly contentious topic. It is clear that we cannot simply allocate more funds from an already stretched budget to finance the sector.

Health costs in Jamaica, like virtually every country in the world, will continue to rise every year as the population ages and technology becomes more advanced and costly. The present model of financing is not sustainable and needs supplementation from either user fees or a health insurance scheme.

Both options are equally unpalatable for persons who have seen their incomes eroded by inflation and devaluation. Stoking opposition to such reforms by playing on the expected backlash from the people will score cheap political points but will be the death knell of health reform. Whichever party forms the opposition after the next elections must work with the Government to enact the necessary reforms.

It is undeniable that the movement for improvement of the health sector has energised Jamaicans from all walks of life. What is needed is to channel this energy into meaningful discussions as to how to solve the problems. The ones who use the system should have a say in what needs to be done and buy-in from the people be sought before any radical changes. At all costs the poor and those at extremes of age must be protected. After all it is these most vulnerable among us who will inevitably feel the brunt of any further deterioration of the sector.