Editorial: Mr Dalley’s path to reform
Horace Dalley has started his new stint as health minister with a commendable display of empathy. And not only in his public soothing of his simpering predecessor, Fenton Ferguson. At the weekend, he met with the parents, mainly mothers, of the 19 pre-term babies, whose death came, in the public's mind, to be emblematic of Dr Ferguson's mishandling of the health sector.
But while good bedside manners might claw back some political points for Mr Dalley, his government, and his party, it won't be sufficient to fix the problems of the public health system, including declining confidence in the state-run hospital and clinics. On that front, Mr Dalley faces a tough slog, including driving efficiency in these institutions and holding their managers, and ultimately himself, accountable for outcomes. He has to be willing, too, to tell Jamaicans some hard truths about the economics of health care and be willing to implement policies consonant with those realities.
Dr Ferguson may well have been right about having been kept in the dark about the outbreak of klebsiella and serratia bacteria in the two hospitals where the babies died. He was right, too, that health care-associated infections like those that affected the babies are not peculiar to Jamaica.
What, however, is clear from the recently released audits of selected public hospitals is that the conditions in these institutions exacerbated the circumstances in which nosocomial infections thrive. And a large part of the problem relates to the inefficient use of limited resources, which is another way of saying poor management. Herein lies Mr Dalley's dilemma and opportunity.
15 per cent of budget
The J$49.5 billion earmarked for health this fiscal year accounts for around 15 per cent of the Government's budget, excluding debt-servicing costs. The proposed expenditure is 20 per cent more than the previous fiscal year. Given the country's difficult fiscal situation, there won't be significant increase in the near future.
Health system managers will have to do more with what is available - and certainly much better than what the audits revealed. It is also better to have more soap and detergent around hospitals, but shortage was not the fundamental cause behind the failure of staff to follow basic hygiene for washing hands; or the deficiency of managers in ensuring that contracted cleaners provide staff with appropriate buckets or mops.
So, among Mr Dalley's first tasks must be to determine whether the inherited boards and chairmen of the regional health authorities have performed well; whether they have been accountable; and whether they have held the managers of their various institutions to account. The likely answer will be no, in which event he should replace them with competent people, with no consideration for political relationships.
Further, Mr Dalley should end the pretence at the affordability of totally free health care at public institutions, starting with accepting the declining quality of service since the introduction of the no-user-fee policy in 2008 and telling people the truth about it. We appreciate the political sensitivity of this issue, but the minister, if he reviews a 2013 CAPRI survey on the matter, will find that only 52 per cent of patients believe the Government to be primarily responsible for health care. Forty-five per cent feel it to be a shared responsibility. He thus has a workable platform from which to make a case, with the overwhelming support of healthcare professionals.