MEDICAL DIAGNOSIS: A chronic shortage of drugs and other resources diminishes the quality of service delivery.
ACCORDING to Dr. Carolyn Gomes, the 2008 move that led to the removal of user fees at public health facilities was both a blessing and a curse. On the one hand, it helped to improve overall access to health care, but the burden it placed on centres across the island, without any marked increase in resources, was “horrific.”
Dr. Gomes was delivering the findings of an extensive health economics research carried out by the Caribbean Vulnerable Communities Coalition (CVCC), which sought to assess the performance and functioning of Jamaica’s health-care system. “The removal of user fees opened up a great demand on the health-care system, but [almost] 10 years later, the amount of bed space, medical supplies and other resources has not moved. There has been no noticeable increase in resources allocated to meet the increase in demand,” Dr. Gomes, CVCC Executive Director, noted, as she addressed a public forum at the Jamaica Pegasus Hotel last Tuesday to disclose the findings.
The public forum was convened to address, among other things, the state of the health sector, improvement to service delivery, management and financing of health.
“It is widely accepted that the sector is underfunded,” Dr. Gomes stressed. “The vision for Jamaica’s development plan is for a healthy society. We need sustainable financing for health care.”
The CVCC research (conducted over a three-year period) used World Health Organization (WHO) building blocks as a framework for analysis of the findings. “Jamaica doesn’t meet that standard as well as it should. We are a small country with four separate health regions for 2.8 million people. That negatively impacts the quality of service delivery,” the former medical doctor argued. “Having worked in a hospital, it’s often a choice between a dirty something and a person’s life, and it shouldn’t be. There is a chronic shortage of drugs and medication. Some facilities are not prepared for physically challenged patients, and that also affects the quality of delivery.”
Improvements are needed across the board, the former Jamaicans for Justice Executive Director emphasized. “The conditions under which we ask medical staff to work is mind-boggling. The long waits and understaffing is cause for concern,” she said. “And we are working with some antiquated structures that by their very nature are problematic. We are burdening the staff and underserving the patients.”
To this end, the recommendations stemming from this ground-breaking research are crucial for the current government. “The Ministry of Health needs to reorganize how it’s delivering health care at all levels. It hasn’t worked as it should and we need to step back and focus on policy for strategic health-care delivery. We need to plan, allocate and use our resources better. Our job is to keep people out of hospitals,” Dr. Gomes said.
Public education is also vital. “Clear communication channels for the standard of health-care delivery are crucial, especially in rural areas. Educate the health staff and involve the communities in a more structured way,” Dr. Gomes said. “Overall the basics of the delivery of health care in Jamaica need to be revisited.” Funding for the health economics research was provided by the European Union.
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The overwhelming consensus by health-sector officials who participated in the recent public forum is that Government has fallen short in supporting the fee-removal policy. “Can the Government afford to be payer and provider of health-care?” asked Carmen Johnson, new president of the Nurses Association of Jamaica (NAJ). “Matter such as the nurse-patient ratio in our facilities needs to be urgently addressed.” For research consultant Charlton McFarlane, the Holness-led administration will have to devise workable solutions to fill the gaps before they become volcanic craters. “There have been only marginal increases in the health budget – two years after the fee-removal policy came into effect. After that, it went down,” McFarlane noted. “No one should be denied care because of inability to pay. The Government should devise a system to support those who can’t pay. There are serious deficiencies at the primary and secondary levels of the system. Way more resources are needed. Where will we get those resources from and how will we get them?”
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