Time to revamp the regional health authorities
It would seem to me that we have come to that swing in the pendulum, where the operations of these reginal health authorities need to be re-evaluated. The regional health authorities were introduced by a People’s National Party (PNP) Administration in 1997 to streamline and decentralise the offering of health care throughout the country, especially to rural areas. But, over the years, there have been problems with the semi-autonomous status of these authorities and their ability to deliver health care to the populace
The impasse between the Government and the Jamaica Medical Doctors Association (JMDA) has left many of us nonplussed as to how any government could be having what appears to be an adversarial relationship with doctors at a time when the country is under the existential threat of a deadly pandemic.
It is reprehensible that at a time like this doctors have had to go on “sick” leave to have their grievances addressed. These are grievances that did not arise overnight. To allow situations to drag on until force had to be applied is not just myopic, but downright incompetence.
Now that the doctors have resorted to what Jamaicans know works best – block the roads to get social amenities or justice, or go on sick leave – the Government has engaged them in dialogue and there now seems to be a path towards a resolution. But it should not have come to this. The doctors and nurses, whose turn will soon come, are not unmindful of the problems that plague the health sector – poor remuneration, lack of resources and equipment to do their work well, long work hours and so on. While there has been some improvement, there is never enough money or resources to do what is necessary.
The novel coronavirus pandemic has only highlighted the glaring inequalities in the system and the abysmal lack of resources needed to provide health care for the Jamaican people. Doctors and nurses do the best they can with the hand they have been dealt. And it has been a hard hand, for a long time. As members of an essential service and in fealty to their Hippocratic oath, they have soldiered on, often at great personal expense. Many of them are at a breaking point because of having to work arduous hours, especially under the constraints imposed by the pandemic. They are mentally exhausted and themselves face the peril of infection from the virus. Indeed, a number of their colleagues have either died or become seriously ill from the virus. Now the Delta strain beckons.
I do not believe that our professionals are unaware of the difficulties successive governments have faced in maintaining the health system. But, what has distressed them is the extent to which governments have taken their service for granted. In the present imbroglio, they are particularly chagrined that the Government seems to be going back on promises that it had made to the sector. There is concern over gratuity payments and even payments that should have been made to some junior doctors who worked in the blitz vaccine roll-out.
There seems to be a big elephant in the room. The South East Regional Health Authority (SERHA) figured prominently in the recent negotiation. On the face of it there seems to have been a serious disconnect between the Ministry of Health and Wellness and that particular authority over hiring of doctors and their terms of service. The ministry seemed unaware of the details of the duration of their contracts and compensation for their work.
To the extent that this is so, it would seem to me that we have come to that swing in the pendulum, where the operations of these regional health authorities need to be re-evaluated. The regional health authorities were introduced by a People’s National Party (PNP) Administration in 1997 to streamline and decentralise the offering of health care throughout the country, especially to rural areas. But over the years, there have been problems with the semi-autonomous status of these authorities and their ability to deliver health care to the populace.
In my view, they now appear to operate as silos and have become a bureaucratic cog in the efficient delivery of health care. This might have been part of the reason Rudyard “Ruddy” Spencer, when he became minister of health, commissioned a task force, led by Dr Winston Davidson, to have an in-depth look at the operational efficiency of these bodies. This was done in 2007. Since then, there is no clear indication that they are serving the purpose for which they were introduced in the first place. There are still questions about their legality, certainly about their competence in providing efficient health care to people.
I am not sure if the Davidson report was ever made available to the public, but from what can be gleaned, it was not in scintillating support of the regional health authorities. To my mind, the question remains regarding the level of communication that takes place between the Ministry of Health and Wellness and these authorities and whether the work of the ministry, from a bureaucratic standpoint, is being stymied by these authorities. They seem to be operating without much jurisdictional control from the ministry. It would be good for the country to know whether the time has not come to restructure or revamp them so a better system can emerge. Dr Tufton, the minister of health, can advise us. The sooner the better.