Health Care – A Sober Reflection!

IN recent months past and present, several discussions and activities have surrounded the health care situation in St Lucia with particular emphasis on the commissioning of the OKEU Hospital and the St. Jude Hospital.

I have had during the last year good reasons, directly or indirectly to utilize the services of the three major Health Care Facilities in this country. The experiences and utterances of the general public ranged from: satisfactory to disgusting, the inordinately long waiting time versus the quick and caring disposition of hospital employees; from excellent to mediocre services; from “I ain’t paying (government ting) to, I really had to find the money to pay”.

All of these and more, in whatever form they came, brought to mind the state, management and service delivery of our health care, particularly that which is fully government operated.

Article 25 (1) of the Declaration of Human Rights on Health Care, to which we subscribe, in part calls for “ the access to medical services, sanitation, adequate food, decent housing, healthy working condition and a clean environment. Consequently, I am instructed that everyone has the right to a standard of living which is adequate for the health and well-being of himself/herself and family and further, that those, because of sickness, disabilities or without any means of livelihood, should be assured of a measure of security, now dubbed “a safety net”.

We can safely boast, that with the advent of Internal self-government and later Independence, St. Lucia has by leaps and bounds, made health care accessible to all, but we must also agree that with an up-swing in national growth and development, the pressures on the health sector demand changes and adjustments to meet present day challenges.

Government, therefore, must consider its substantive role in the provision of a qualitative health care for all. Health is considered a “public good” for all and sundry.

Successive governments have considered, in one form or another, the retooling of the sector but are yet to deliver or arrive at a good place in this endeavour.

It has been argued that where government has complete control of the Health care services, invariably, inefficiencies plague all facets and sectors of that service, notwithstanding the high levels of qualified personnel and medical professionals who service the sector.

St. Lucia can boast, given our size and population, of having a surfeit number of medical professionals in all areas of medicine and its related and dependant services. We have not and must not be complacent in this regard.

The medical field I am told is still evolving and change and adaptation will be ever present in the sector. I here pay homage to all our doctors, nurses, medical technicians and all others who bring pride to us by their accomplishments and dedication to duty.

This brings me to the question of the management and administration of these institutions. Closer home, the commissioning, over fifty years ago of the St. Jude Hospital, at the behest of the Government of St. Lucia, under the leadership of the visionary John G.M. Compton, gave a new lease on life to our health care sector, particularly in the southern zone of the island.

The management and administration of this institution by the Sisters of the Sorrowful Mother, gave us a unique model which has stood the test of time to this very day.

A team of medical professionals, the Government of St. Lucia, administrators and the Board of Directors, made it possible for this medical institution to survive, even when its fortunes were considered a roller coaster ride. It continues to flourish today while still maintaining its charitable and compassionate outlook.

Though the savagery of fire some nine years ago brought about the wholesale destruction of the physical structure and forced the relocation to the “less than ideal conditions” of the stadium, it did not efface the management and administrative concepts and practices which must be extolled.

The relationship between the Government and a Catholic Medical institution, headed by the Sisters, gave us this iconic institution. That relationship bears resemblance to the Public Private Partnership (PPP) concept that the World Health Organization attaches credence to, for the equitable delivery and cost effective health care services.

PPP is not privatization. My discussions with a competent, well versed, balanced and respectable medical practitioner,`allayed my fear and apprehension about the subject of a perceived “privatization” notion of the OKEU Hospital which is being discussed currently and in the public domain. Such misguided views can only add to the cynical position that some of us harbour, given our suspicion of those who make the pronouncements.

Government’s aim therefore is to create a win-win situation for all concerned. The concept is described as: “A long term contract between the government and a private party for the provision of a public asset or service in which the private party bears significant risk and management responsibility, with remuneration being linked to performance”.

In this sense, a government shall not relinquish its responsibilities to the people of the nation and must be held accountable for the appropriate policies and regulations which are designed to guide the undertaking.

Let me borrow in part from the UWP’s (MY PARTY) Manifesto for the 2016 General Elections, a few statements which are meant to help form the policy guidelines to shape the health sector: 1) To establish a structured, systematic, evolving and affordable health care system. 2) The current system is characterized by poor management………. a lack of collaboration and synergy with the private sector, causing waste, duplication and inequity in access to health service. 3) The sick are being held in dilapidated conditions, while the young people are being denied access to sporting facilities.4) To constitute an advisory Board to assist in planning and managing the health sector 5) Increase sources of finance through Health Insurance. 6) Design a framework to maximize access to private health insurance. and 7) Develop a PPP in the Health care sector.

These are no mean feat and to accomplish them effectively, our government must engage all interested parties in discussions and consultations before hammering home the final plan.

This could help in disarming the protagonists and set straight any misconceptions or scare mongering that may obtrude during the process. Individuals and communities must play an active role in the decision making process, without show-casing their political colours or biasness.

Further, the suspecting electorate dislikes things being forced down their throats, thus this providing fodder for the naysayers.

Health care should not be treated as a political football, for when the rain falls, “it wouldn’t fall on one man’s house”.

Like water, it is a public good and we all stand to benefit from the sector. Our commitment must be strong, our intentions pure, while trust and good faith should guide the path.

My experience tells me, that local political interference have been known to hinder the progress of many a public good or service. Health care being one of these. Therefore, a determination and enlightenment of sorts must be had in order to combat the negativity and deflate the misinformation that abounds.

To help us with this a cursory glance at the Ontario Health Insurance Plan (OHIP), the Cayman Island’s Health City and the history of St. Jude Hospital among others, could help in the circumstance.

Too often in this country, we seek to destroy the messenger while ignoring the substance of the real message. The health care in this country is desperately in need of an injection of capital, sound management, purposeful administration bolstered by compassion and goodwill.

Hence a Public Private Partnership is worthy of thoughtful consideration in mitigating the perennial criticisms and difficulties which plague the health sector.

The government of necessity will continue to play a critical role in the executing, sustaining, formulating and administering the policies and regulations pertinent to the sector. It will not be devoid of a financial responsibility. All of which must be geared to strengthening our ability in the delivery of affordable health care services and thus giving our people value for money.

This concept also opens up an avenue for the enhancement networking and the sharing of best practices in the sector.

Finally, I make this plea, upon sober reflection, for us to work towards “a health care service that is not a privileged commodity for those who can afford it but one that is a fundamental right for all”.

For this reason, a clarion call must be made to all who are capable, to support and contribute to the venture, for the good of our nation.