Editorial | Fixing UHWI 

Chris Tufton’s review committee is probably right that fixes to the legislation under which The University Hospital of the West Indies (UHWI) operates, including streamlining some board positions, will help address the governance crisis, and weak accountability, that has long dogged the institution.

This newspaper therefore urges the government to move quickly on the committee’s recommendations, including its proposal for an external change agent to help the hospital board develop a programme, and schedule, for the implementation and monitoring not its own suggestions, but those contained in the auditor general (AuG) December report of an investigation at UHWI. The AuG highlighted a culture of arbitrariness and disregard for the government’s procurement rules that put at risk taxpayers’ resources.

But a close reading of the review committee’s report, especially in conjunction with the University Hospital Act, reaffirms several critical facts.

First, as The Gleaner held from the start, it ought not to have required this committee -  notwithstanding the competence and integrity of its members - to arrive at their conclusions.  The recommendations are, for the most part, what would be expected from an attuned board of governors, especially one of relative recency, with a chairman appointed with a mandate to address the governance crisis. This, of course, supposes that the board had the time and space to act.

From The Gleaner’s perspective the more important takeaways from the entire episode are that:

• The long-term governance failures at the UHWI were not because of the shared ownership of the hospital between the Jamaican government (which pays 70 per cent of its costs) and The University of the West Indies. As the review committee pointed out, similar models of ownership/management of teaching hospitals exist elsewhere.   Notably, the committee doesn’t believe there is any need to change the model.

• The rot at UWHI set in largely because of the failure of successive chairmen (and their boards) to exercise the authority, explicit and implicit, provided in the legislation, to establish and enforce accountability systems. The chairman and boards either misapprehended the scope of their powers, or were prevented, or were too timid, to use them.

• Should the government be slow in acting on the review committee’s recommendation, the current board and its chairman, if they possess the will, can and should proceed with many of the reforms the hospital needs.

• Successive health ministers, including Dr Tufton, fell woefully short in their most basic obligation oversight, such as requiring the UHWI to produce annual financial reports for tabling in Parliament.   It is nearly a decade since Parliament received the UHWI financials, and the last ones tabled were at least three years overdue.

Despite its strong clinical reputation among Jamaica, UHWI has faced periodic controversies over governance and management, which have elicited numerous reports, and recommendations, for reform.  This latest episode resulted from an operational investigation by the auditor general, Pamela Monroe Ellis, which unearthed that hundreds of millions of dollars of contracts had been awarded without following procedures laid in the government’s procurement regulations.

In many instances documents relating to contracts were reported as lost, and there appeared to be a habit of splitting tenders so that they fell below the threshold for competitive bidding.  The auditor also found cases of the hospital using its tax exempt-status to import products duty-free for the benefit of private firms, and at a cost to taxpayers.

In the debate ignited by the findings, it has been suggested that part of the problem was the tension caused by the shared ownership of the hospital, including whose procurement rules should prevail - those of the Jamaican government, or that of the UWI, an institution owned by Caribbean governments. 

They ought not to have. It is clear that despite its association with UWI, that the hospital operates within Jamaica’s public health system; that the Jamaican government pays the lion’s shares of its expenses; and that the Jamaican health minister directly appoints 44 per cent of its board members, including, on this newspaper’s reading of the implicit intent of the law, its powerful chairman.

By any reading, The University Hospital of the West Indies, as the review committee concluded, is a Jamaican public body as defined by the island’s Public Bodies Management and Accountability Act (PBMA), subject to the governance requirements of that law. Further, any doubt about this status was cleared by private legal advice sought by the institution in 2021 which confirmed the position and the hospital’s obligations.  

The review committee has rightly highlighted the anomaly that the UHWI legislation makes no provision for a CEO. So the person occupying that role doesn’t formally sit on the board, while the chairman of the hospital’s medical committee, and several members of the UWI’s medical faculty, are members. That must be rectified.

This doesn’t mean there is a vacuum of authority.  The legislation charges the board to, among other things, make regulations “for securing the proper, efficient and economic maintenance, management, administration, organisation and use of any facilities or services of any description provided by or at the expense of the board at the University Hospital or elsewhere”.

There is an implicit expectation that the chairman will exercise the effort to get the job done. It is the only board position for which the law explicitly contemplates remuneration.