Christopher Tufton | Without malice or protest

Small states must look to the South for health human capital support 

As the world turns so are the uncertainties of small island states who are trying to determine what next for the treatment of their populations through a sustainable healthcare model. 

Caribbean populations live close to some of the world’s most advanced health technology and healthcare systems in the North, but access is limited to those who can afford to travel and pay for care. Wealth also attracts the skilled professionals needed to run these systems, many of whom were trained in education systems originally supported by Caribbean governments.

What is clearer each day is that the global rules-based system, once defined in the World Health Organization and its UN affiliates or our substantial bilateral partners like USAID or the EU that once allowed for some predictability is being disrupted, perhaps, for good reason, but nevertheless leaves smaller island states with no less certainty about who to depend on except themselves or other willing partners for a sustainable path to better healthcare. 

The recently concluded World Health Assembly charter, while well intentioned, is unlikely to change the attitude of larger countries towards the recruitment or partnerships towards expanding healthcare worker training. The COVID-19 pandemic should have taught us that together we are stronger, but apparently, it has not enough. 

SIGNALS ARE CLEAR

Small island states should appreciate that the signals are clear. We must determine our best options within the context of a world that offers no special favours except where there are mutual self-interests or co-opted interests. 

Caribbean leaders face few choices in this new and increasingly transparent world. Self-sufficiency is an ideal option but not likely to be achieved in healthcare given the small size and the sick profile of our populations. Further, no country, no matter how powerful, can fully guard against health risks on their own. COVID-19 and Hurricane Melissa taught us that. 

It starts with prevention and primary care. Lifestyle changes must be pursued but require cultural and mindset change, only achieved through committed political will. Lifestyle practices largely influenced by our heritage and increasing Western influence must be challenged as a primary source of our ills. 

Excessive ultra-processed foods, salts, sugars, fats, tobacco, and alcohol should be seen as enemies of good health. A refocus on family and community, as part of support systems and good mental health, should become part of the social determinants of health. This cuts across ministries and agencies and should involve the mobilisation of all of society. The health of our society is everybody’s business. We need a new health-for- all agenda grounded in behaviour change along the life stage. Jamaica has started, but there is much work to be done. 

CHALLENGES

In this dynamic, the trained healthcare worker should be the glue that binds communities together for better health outcomes. There are two challenges with this, however. Local healthcare workers do not sufficiently see their role as having this greater responsibility. The current culture within our health system may not be sufficiently sensitive to mindset changes, including but not limited to improved patient care. We have become too impatient and complacent. 

Leadership must provide the vision and critical support to mobilise our healthcare workers as the catalyst for change even if it becomes a disruption to those who are too comfortable with the current state. Culture changes slowly and with consistent deliberateness. It is up to us to make this happen. 

Even with this effort, it is unlikely that change can come solely from within. Caribbean countries are suffering from a brain drain of health human capital, and low replacement rates make it almost impossible to respond to the sick profile of our populations much less to pursue cultural changes in lifestyle. And Caribbean people should expect very little help from our closest and traditional neighbours given their current priorities.

The best option lies with South-South cooperation through pragmatic enlightenment of mutual self-interests. 

The evidence supports the need for small countries to see better healthcare delivery through partnerships with countries like India, The Philippines, and African countries like Ghana, where human capital is more abundant, training systems are compatible, and technology has reduced distance to a click away. 

These countries have made significant strides in health training and technology and are more anxious to share their know-how. Equally, despite our size, Caribbean countries can also provide value in areas such as immunization systems and the primary care model, paradoxically inherited from our colonial past. 

HOW JAMAICA CAN BENEFIT

Over the past year, Jamaica, has pursued an  MoU in health-worker training and collaboration with India, The Philippines, Nigeria, Ghana, and with good reason. Our closer neighbours are not likely to solve our human- resource-for-health challenges and, in fact, are likely to exacerbate them. There seems to be no appetite also to support collaborative efforts in training and expanding the pool.  

So as it relates to healthcare workers for small island states in the region, the future is not with the West but with the East and South. It is a pragmatic response to a socio-economic challenge. It is clear that our healthcare policies must pivot to a more sustainable path of forging relationships in more distant places. This is not to discourage existing or future partnerships with the West. 

We must continue trying, as the one-world approach to the principle of universal healthcare is an ideal we should never abandon. But our realities are increasingly obvious. We need additional solutions, and we must be deliberate about pursuing the best healthcare services possible for our people.  The solution lies not in our traditional mindset or even our traditional partners but in our willingness to pivot our efforts and mindset, without malice or protest. 

Dr Christopher Tufton is Jamaica’s minister of health and wellness. Send feedback to cctufton@gmail.com.