Fix Public Health - Stakeholders tell how they would solve the resource issues in the health sector
Stakeholders are urging that Jamaica's ailing health sector be given an immediate shot in the arm, in order for the country to have a fighting chance of achieving a healthy nation. As far as they are concerned, an unhealthy nation can only lead to unhealthy results in every aspect, severely hampering productivity and development.
It is critical, they believe, to implement a simultaneous, multi-tiered plan of action to once and for all resolve Jamaica's health crisis.
The Sunday Gleaner has asked prominent figures in the health sector to share their views and state how they would fix the problem if it were within their power.
If you had the courage, what would you do to fix the problem of lack of finances in the public health sector?
DR ALFRED DAWES
President, Jamaica Medical Doctors Association
The health sector is in a deplorable state, largely because of the lack of finances to upgrade and maintain infrastructure and machines, as well as to provide adequate supplies needed to deliver an acceptable standard of care. To address this problem would need a dual approach to cut wastage and to find a sustainable means of funding the health care system. I would endeavour to make hospitals as energy efficient as possible by the use of solar energy, changing out inefficient cooling units and machines for newer cheaper-to-run units and educating the staff on conservation practices. A push for outpatient and laparoscopic surgeries has been shown to decrease the costs associated with keeping patients in hospitals and would be implemented.
Everyone in charge of the procurement and delivery of supplies would be fired and a complete overhaul of the system done to reduce duplication of tasks and improve efficiency. Cutting the large number of administrators across the island would mean more health dollars going straight to providing care instead of funding a bloated bureaucracy.
I would reintroduce an administrative fee which would be small enough for 80 per cent of Jamaicans to afford. The marginalised 20 per cent would continue to be subsidised be the Government. A PATH-like programme would help to identify those vulnerable persons. Fines for littering, dangerous traffic violations and sin taxes on cigarettes, junk food and sodas would go into a health fund used to pay for the unhealthy results of these products and practices. These small measures would add up to result in significant savings and a measurable increase in the coffers of the clinics and hospitals, allowing them to improve their services.
Executive Director, Jamaica Cancer Society
As health-care costs continue to increase at rates higher than the general inflation rate, there needs to be increased focus on controlling health-care expenditures in the public health sector. There needs to be better forecasting of the demand for health care and allocating health-care resources more efficiently. I would shift the focus from curative action to that of health promotion and the prevention of ill health. I do believe it is accurate to say that 70 per cent of diseases and conditions contributing to mortality and morbidity could easily be prevented if appropriate environmental and lifestyle measures are taken. I would therefore channel more resources to disease control and prevention through a multisectorial approach which would serve to address these environmental and lifestyle factors. The National Health Fund would need to expand its range of drugs, addressing chronic diseases and its Drug Serv locations for increased access by more Jamaicans who need this service. I would create incentives to address the exodus of critical health professionals which is threatening the sector's ability to expand and deliver quality and accessible health care. I would work more closely with the private sector, regional and international stakeholders to attract more investors to build more hospitals, equip them and assist in maintaining them.
DR SHANE ALEXIS
President, Medical Association of Jamaica
Jamaica's public health sector is in crisis. Chronic under-funding, low employee morale, disgruntled patients, shortages and delays are some significant features of the sector. While we have achieved some internationally acclaimed health indices, such as our immunisation programme, we must focus on our weaknesses.
In my opinion, sustainable funding solutions and consensus building are now imperatives for the sector. Politics should have no place in health care. Similar to the EPOC, the establishment of a 'health sector reform task force' is crucial and should include the participation of the private and public sector as well as the Opposition.
Effective public-education programmes encouraging companies and individuals to learn to manage their health, and do so consistently, should receive financial incentives to continue. Enforcement of existing laws on environmental practice and public health should be prioritised. Chikungunya and the Riverton smoke combined will cost the Government billions. Both were largely preventable.
A recalculation of the percentages of various taxes that are allocated to health should be done now. The population numbers and disease profiles have changed significantly since they were initiated more than 10 years ago, as in the case of the National Health Fund.
Government should focus on health-related policy and education and divest operations such as diagnostics to the private sector.
There is no single solution because the problems are complex. Poor health has an impact on productivity. The decline in the Jamaican economy last year is suspected to be related, in part, to workdays lost because of chik-V. The true cost of a quality, affordable and a patient-centred health system is yet to be calculated in Jamaica. First, we must calculate the cost then we can determine how to fund it. Consensus through cooperation will not cost us much; the time we take to make decisions could cost us everything.
Chief Executive Officer, Private Sector Organisation of Jamaica
If I had the opportunity to fix the healthcare finances I would firstly look at what money is being spent that could be avoided. So 70 per cent of health-care costs relate to non-communicable diseases, which are avoidable. So I would put some of the funds in preventative programmes. As we start to see the benefits of prevention, which includes working with the authorities to enforce traffic laws, then I could better assess the real needs and allocate costs accordingly. I would also fund a properly run health insurance scheme through private carriers of choice, but insist on health care for all.