St Patrice Ennis | Government outsourcing policy dangerous
In recent times, the Government has been engaging in irresponsible use of funds to outsource work in the public sector without merit.
The Gleaner article dated June 15, 2018, regarding the outsourcing of work by Petrojam to a Canadian consultant, comes readily to mind. The most recent example is the outsourcing of diagnostic services in the public health sector. In such cases, money could have been better spent serving the elderly, sick and poor people of Jamaica.
Admittedly, there are, indeed, many shortcomings within the public health sector that must be addressed and overcome. We are short on resources, staff are overworked and underpaid, equipment outdated, and infrastructure crumbling. However, it is prudent and arguably patriotic to invest in solving these problems to maintain cost-effective public health services.
Case in point, as the trend continues, the Government recently announced a decision to outsource diagnostic services to Biomedical Caledonia Medical Laboratory Limited for J$24.3 million, which has thus far been hailed by some to be money well spent to assist an overwhelmed public health system in delivering more timely services to our citizens.
The diagnostic services to be outsourced include microbiological tests of blood, body fluids, and excreta. Also to be outsourced are eye, ear, and wound sterility analysis. These tests are the functions of the microbiological department of the National Public Health Laboratory (NPHL), Jamaica’s reference lab for health institutions that make up the South East Region.
The reason cited for the outsourcing, according to the Gleaner article dated May 14, 2019, was explained as “a bid to ease the backlog and long wait times at government-run facilities”. The article made reference to the managing director of Biomedical, Barbara Hendriks, who stated, “I know I have the capacity to accept government patients that the national public health system normally would be processing but can’t manage to do.”
In his Sectoral Debate on May 21, 2019, Opposition Spokesman on Health Dr Dayton Campbell justly chastised the Government for contracting out surgeries and not using the money to improve government health facilities. Surprisingly, Dr Campbell did not take issue with the Government’s decision to outsource diagnostic services. This omission or acquiescence on the part of the opposition spokesman may have provided a fillip to the narrative that the public health laboratory system cannot cope with the demands of the public.
To determine whether the Government’s decision to expend J$24.3 million on outsourcing is money well spent, or yet another in a series of dubious government contracts, requires an examination of the issues surrounding backlogs at the microbiology department at NPHL, as well its ability to meet the demands of the public.
The last auditor general’s report (2015) on NPHL did cite a backlog in the microbiological department. According to the report, this backlog was specific to tuberculosis (TB) as a result of the suspension of TB services from 2014. This suspension was lifted in 2016 when the TB laboratory was redesigned and the staff received additional training. However, the report made no mention of backlog in the aforementioned areas to be outsourced or the NPHL’s inability to meet the demand of the public.
It is worth noting that there are some laboratory services that are only offered at the reference laboratory. TB is one such service and is, therefore, unlikely to be outsourced as all suspected cases must go to the reference laboratory for confirmation.
Closed for cleaning
In October 2018, consequent on the many years of neglect of maintenance of NPHL’s building, and the plethora of complaints from the staff of mould-related illnesses, the microbiology department was ordered closed for cleaning from October 2018 to the last week of November 2018. During the closure, both staff and some equipment were relocated to the Bustamante Hospital for Children, where testing continued. On completion of the cleaning exercise, the staff returned to the microbiology lab at NPHL and full microbiology testing resumed.
As previously stated, proper maintenance of equipment is paramount to providing quality and reliable laboratory services. Specifically, the media plates on which the microbiological specimens are placed must be stored in a refrigerator to maintain the highest level of sterility and integrity of the plates. These media plates serve as the medium to grow, identify and isolate organisms. This quality-control process allows the specimens to be free of contaminants to ensure the accuracy of the results.
However, over the years, the refrigerator used to store the media plates was contaminated with mould. This must be replaced in order to reduce the rate of rejected samples and the turnaround time.
This problem could be easily rectified with the purchase of a new refrigerator at an estimated cost of J$2 million. Should the Government replace the refrigerator in the microbiology department, this would eradicate the possibility of samples being compromised by mould infestation, reducing the rejection rate and turnaround time.
This is a known fact in the Ministry of Health. Therefore, it is befuddling to comprehend why the Government chooses to expend $24.3 million on outsourcing when it could purchase a laboratory refrigerator for approximately $2 million and provide the necessary service to the public. Therefore, the public deserves an investigation into the decision to outsource the diagnostic services, including a cost-benefit analysis.
The foregoing is not the only suspicious activity that takes place in the public health system on the matter of laboratory services. One such prevalent example is the practice of doctor-patient referrals to private labs for viral load testing, which is essentially an HIV monitoring test. This type of testing is only done at public health laboratories for public health control and monetary purposes.
When the patient is referred to the private lab for this kind of testing, samples are collected at a cost to the patient of between $15,000 and $24,000. This sample is then referred to the public health lab, which charges the private lab $2,000 to complete the test. The private lab, in return, makes between $13,000 and $22,000 on the referred test from the patient. Clearly all is not well with some of the practices in the public health system, as there seems to be a strategy to exploit the public to the benefit of these private institutions. It portends malfeasance.
There is strong evidence to suggest that precaution should be taken with the privatisation of public health laboratory services. The most notable risk is loss of control over day-to-day operations, whereby lack of oversight and compliance may result in cost-cutting measures that place profits over people.
Public health laboratories are responsible for community care. They are instrumental in prevention control, monitoring of diseases, as well as identifying trends. It cannot be expected of a private lab to do free extensive testing if there is a public health concern. Alternatively stated, public health laboratories do not merely carry out tests; they do disease assessment. Therefore, the responsibility of healthcare, disease management, and disease prevention lies with the Government and should not be delegated to a third party.
- St Patrice Ennis is general secretary of Union of Technical, Administrative and Supervisory Personnel. Email feedback to email@example.com.