Dr Alfred Dawes | The Jamaican health sector: where are we going?
Jamaicans have made the public health system a major talking point in recent times. Aside from the political jousting, much of the conversation has centred on improvement of the health sector. But what exactly would we consider an improved and acceptable health-care sector? The answer depends on who you ask.
For the patient waiting long hours in an overcrowded clinic or emergency department, it would be a public health facility where they could be in and out in a flash. For the overworked staff in said facilities, it would be one where they are adequately compensated and supplied with resources and manpower. But those metrics mean little to officials who have targets of life expectancy, mortality rates, immunisation coverage, etc.
And then there are the dreamers. Those who want to see our health sector reach levels comparable with First-World countries.
Public health systems across the world are almost always criticised by the populations they serve. It matters not the level of care provided or the amount of funds pumped into them. The National Health Service (NHS) in the United Kingdom (UK), for example, is funded by eight per cent to nine per cent of gross domestic product (GDP), yet there are howls of protest from all across the union about underfunding and poor treatment of patients.
The NHS grapples with long waiting times in accessing services and complaints from staff about poor remuneration and unsociable working hours. Not surprisingly, the NHS is the focus of many a political campaign, most recently being used by the pro-leave campaigners in the BREXIT vote.
With a budget of around £136.7 billion, the British public health system is suffering from the same problems we are trying to address. Severe staff shortages are crippling some areas and working conditions are described as horrible by some trainee physicians. The Organisation for Economic Cooperation and Development, in a report, said that the UK had one of the worst health-care sectors in the developed world with respect to staffing and patient outcomes in some diseases.
LONG WAITING TIMES UNIVERSAL
Other developed countries have similar complaints. Although health-care costs significantly less in Canada, long waiting times are a problem. The high cost of health care in the United States results in many uninsured persons being denied access to treatment. The legacy of President Obama will be tarnished by the failing attempt at providing health-care coverage to those Americans through the Obamacare. Although well intended, Obamacare in its present form is unsustainable and bound to collapse without reform. The expense of medical care will always limit the availability of care in the US and a public health sector without universal access cannot be ranked top-tier.
The defenders of our health sector will reel off amazing statistics that we have been able to achieve with what little we spend. Our life expectancy is among the highest in the world. We are dying from First-World diseases such as heart attacks and strokes instead of infectious diseases like other developing countries. We beat polio, malaria, yellow fever and cholera, and our immunisation rates are higher than would be predicted from the allocated resources. Yet, in all of these accomplishments, we agree that we are lacking. Improving on the stats will not be felt by the old diabetic in the crowded waiting room. The old man who has to find money to pay for his prostate ultrasound will not rejoice if one day you tell him that our mortality rate from prostate cancer has fallen. Yes, statistics are a good way to measure our development objectively, but will not be widely accepted as improvements by those who suffer in the broken system.
Our universal access to health care is admirable. But access to what level of care? Will patients be satisfied with top-class surgery with little chance of preventable complications, but wait two years to access the service? Or will we be happy with fast access, but resources are so low that we compromise sterile procedures and patients end up with unacceptably high rates of infections? Should we aim towards having a CT scanner readily available while waiting times to get a scan can be as long as months, or do we want an ultrasound available instantly but with less information than can be gained by the CT? If we funnel our resources in setting up a good emergency-response system but with basic ambulances ready to get patients to the nearest well-equipped hospital, will we then start to complain that there are no doctors on the ambulance to commence care at the scene of the accident?
I would personally love to see Jamaica at a point where we are performing as many laparoscopic surgeries as our Caribbean neighbours instead of traditional open surgery. But I have to ask myself if this is a luxury when we barely have enough resources to perform the essential surgical procedures the traditional way. What if when we become fully adopted to advanced laparoscopic surgery, some young surgeon comes along and calls our system outdated because we are not operating with robots. Do we push to that new level of excellence or do we aim for a point when we are comfortable, instead of chasing technological advances? In other words, should we be aiming for a regular little cell phone for every man, or do we measure the success of our improvements with the number of persons with smartphones.
Whatever we do to improve the health-care sector, it will always be criticised and complaints will never stop, no matter how much money is spent. What we should aim for are indicators of success that are more than abstract statistics. Where the person accessing care should feel like they are getting the best care possible and having the best experience at our public health facilities while undergoing treatment.