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Fixing Health: Effective leadership needed to fix health sector

Published:Monday | August 17, 2015 | 12:00 AMShane Alexis
Dr Shane Alexis

JAMAICA’S HEALTHCARE system has improved and saved the lives of thousands of Jamaicans. Our system is comparable and, in some instances, more advanced than many other developing countries.

Our achievements include increased life expectancy, decreased infant mortality, greater than 90 per cent immunisation rates and strong regulatory framework.

So why does our health-care system need to be fixed? The short answer is that the system has not fundamentally changed to adequately address new challenges or take advantage of new technologies and opportunities.

For example, the last time Jamaica constructed a public hospital was in 1972 – the Cornwall Regional Hospital. According to the Statistical Institute of Jamaica’s website, Jamaica’s population in 1970 was 1,848,512. Between 1991 and 2001, St Catherine experienced a 26.3 per cent population growth (three times the rate of the entire country).

The national census of 2011 reports that our population increased to 2,697,983, with St Catherine reportedly having 516,218 inhabitants.

The parish of St Catherine is still served by a Type B hospital (the Spanish Town Hospital) which was opened in 1952 with five basic specialities, and limited diagnostic services. This has resulted in many patients having to travel to Kingston for specialist care, including diagnostic tests.

Only two CT-scans, one in St James and the other in Kingston, are in public facilities, and these serve more that 2.6 million of us.

The increases in tourism arrivals, highway infrastructure, incidence of cancers and traumatic injuries in Jamaica require trained and motivated personnel, equipment and technology to be available and easily accessible when needed to improve patient outcomes.

In subsequent articles, I hope to effectively highlight some of the opportunities that exist for Jamaica to improve the quality of healthcare offered in the public system. I am of the opinion that to create or identify opportunities and convert them to tangible benefits for the average Jamaican, without prejudice, we will require strong, collective leadership. This article is not a critique of past or present leadership.


The health sector is vast and complex. In the public system, there are 23 hospitals and over 350 health centres, approximately 30 bargaining units within the Ministry of Health, which include thousands of members of the health team.

They are responsible for making the health-care system work. There are approximately 1.5 million encounters with patients between health centres and public hospitals annually. While some groups that represent doctors and nurses may be large or more easily recognised, groups that represent nutritionists, physiotherapists, technicians, administrative and ancillary staff are just as important in allowing the health team to deliver care to our patients. 

During past decades, our national policies on health-care delivery quite often appear to be a combination of political and technical considerations in various ratios and with variable outcomes.

A more recent example of a mixed approach to health policy could be the ‘no-user fee policy’. Ostensibly, there are many stakeholders in the sector with many concerns. Successful reform of the sector will require consensus and cooperation around a patient centered system. Without this, the mistrust within/of the sector worsens. To provide the necessary leadership required to improve our sector, leaders must remain focused on what is best for the patient.

Many years of disappointments, missed deadlines, broken promises, stalled negotiations on salaries and benefits for health workers with the Ministry of Finance have fuelled the mistrust in our sector. Differences in views or opinions should not make us enemies, especially if the positions advanced are based on facts presented after scientific research. Constructive debate and discussion can lead to robust policies that will aid our development. We have spent too many years arguing with each other and, therefore, we have not achieved as much as we had hoped to.

The great leader Nelson Mandela is attributed with the quote, “If you want to make peace with your enemy, you have to work with your enemy. Then he becomes your partner.” Our leaders must empathise more with each other to build understanding and, eventually, trust. We must truly become partners in the process; continuous dialogue and mutual respect will help us overcome our fears, concerns and differences.

All stakeholder groups, including the political directorate, must ensure credibility and continuity in the course of the leadership of the group they represent. The democratic cycle of change in leadership, including at the level of the Minister of Health, should not cause a change in the objectives of the country or of any of the associations involved in health-policy development.

That, therefore, places even greater emphasis on inclusive leadership to involve all stakeholders in the determination of our policies. That, in turn, I hope, will help ensure that they are carried out beyond any election or administrative cycle.

The current example of the Economic Programme Oversight Committee (EPOC) demonstrates public and private sector joint leadership characterised by consistency, transparency, credibility and, importantly, has delivered positive results in the nation’s interest. The model should be replicated for the health sector.


As we navigate the tense and difficult economic and social climate in Jamaica today, it is now even more necessary to build alliances across sectors. The leadership required will not only have to determine the best way forward, but must also lead its implementation.

That leadership must also motivate the health team by showing appreciation and empathy on the challenges faced on a daily basis in carrying out their jobs. We must quickly rally around our staff to retain them and attract new members to our team.

Our national motto ‘Out of many one people’ reflects the diversity of our history. The task of achieving good-quality, affordable health for all Jamaicans should unite us all.

Illness does not discriminate, and, therefore, neither should we. Diversity of views and our approaches to fixing the health sector must now be effectively distilled then purified, to be then implemented in a timely manner.

So who should lead us in fixing the health-care system in Jamaica? Politicians, doctors, nurses, funding agencies, the IMF, members of the Diaspora or wealthy individuals?

My answer is that we all have a role in providing and ensuring good leadership to address the problems we face.

Effective leadership in our own homes, churches, and businesses on health-related matters is as important as leadership in the health sector. If we turn a blind eye or claim ignorance on the importance of good health, then we risk becoming a part of the problem.

Let us not forget the impact (ongoing) of chikungunya (chik-V) or the anxiety of the threat of Ebola less than one year ago.

The quality and substance of our collective leadership from all stakeholders will determine how successful Jamaica will be in fixing our health-care system. Email: yourhealth@gleaner

- Dr Shane Alexis is president of the Medical Association of Jamaica.