Health Sector Reform Programme - Bringing healthcare closer to you!

	Ministry of Health
	Health Sector Reform Programme of Trinidad & Tobago Bringing Health care closer to you !

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Please choose a question below to get the answer.

Is it true that the Ministry of Health has been reorganised?

In his 1998 budget speech the Minister of Health promised to make pharmaceuticals for the treatment of some chronic diseases more affordable. What happened with this promise?

What do RHAs actually do?

To whom can the public go to redress grievances against the health system?

I am a public service nurse working in a hospital. Why should I leave the public service and work for an RHA?

Is there a long-term plan guiding the Health Sector Reform Programme?

What are some of the priority projects and programmes being undertaken to improve health care in Trinidad and Tobago?

Why has the Government of Trinidad and Tobago adopted health sector reform?

Is there any role for the private sector in the reorganisation of the health system?

What are some of the major health problems now afflicting our people?

What is the Government doing to curb the incidence of HIV/AIDS in T&T?

Is it likely that the HIV vaccine will cause AIDS?

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Is it true that the MOH has been reorganised?
Yes. With the introduction of the Health Sector Reform Programme and the Regional Health Authorities, the Ministry of Health is now vested with responsibility for all health policy, planning, monitoring, information provision, regulating, financing and purchasing of health services.

In his 1998 budget speech the Minister of Health promised to make pharmaceuticals for the treatment of some chronic diseases more affordable. What happened with this promise?
In March 1999, the Private Pharmacy Programme was launched. Under this programme, selected medications for chronic diseases are now available at prices which are considerably cheaper than previously obtained. In some cases the price reduction to the public is as high as 50%. A list of the medications covered under this programme is available from your pharmacist.

What do RHAs actually do?
RHAs are autonomous statutory bodies functioning as the providers of health care services to all residents in their respective regions. RHAs were created to provide health services to the population in a more timely, appropriate and effective manner. Under the RHA Act RHAs own and operate primary and secondary public health facilities located in their regions. Tertiary health services are provided at the Eric Williams Medical Sciences Complex and the General Hospitals in Port-of-Spain and San Fernando. Every year the RHAs develop Annual Service Agreements (ASAs) with the Ministry of Health, and in the case of the TRHA, the Tobago House of Assembly. The RHAs are expected to operate based on these ASAs. Funding of the individual RHAs is based on the cost of running those services agreed on in each ASA.

To whom can the public go to redress grievances against the health system?
In each RHA there is a Customer Relations Office and a Customer Relations Officer. The RHA Customer Relations Officers currently operate within the main hospitals and can be reached by in-house phone extensions. Their job is to intervene and address client issues and problems. These officers have been trained to undertake a proper analysis of issues and problems as they arise, and respond to the clients. If a matter requires more in-depth examination, officers are trained to follow up their analysis with a written response to the client within seven to ten days and also provide a report to the head of department or facility.

I am a public service nurse working in a hospital. Why should I leave the public service and work for an RHA?
In order that the RHAs fulfill their mandate effectively, so that the population can benefit maximally from the decentralisation of the public health care system, it is necessary that the staff at all public health institutions come under the authority of the RHAs. All nurses are to be invited to join the employ of the RHAs with an enhanced remuneration package. When you transfer, all your leave and other benefits that you are entitled to in the public service will be honoured. All nurses will be eligible for pensionable employment with the RHAs and all your past benefits in the public service will be preserved for pension purposes. On transfer, you will automatically join the RHA contributory pension fund with enhanced benefits. Under the RHA Act, your bargaining union is vested with the power to continue representing you.

Is there a long-term plan guiding the Health Sector Reform Programme?
Yes. The National Health Services Plan (NHSP) guides the human resource and infrastructure development required to bring about the proposed changes in our health sector. The NHSP also outlines the strategies being used to improve service delivery and shift the focus from secondary, tertiary, curative care to primary level preventive care.

What are some of the priority projects and programmes being undertaken to improve health care in Trinidad and Tobago?
The entire Health Sector Reform Programme is a priority undertaking, but each year the Ministry of Health and the RHAs cater for some major projects and programmes. In the financial year 2000/2001 the areas catered for under the health care budget are:

The introduction of a National Health Insurance System.

The expansion of the Emergency Health System to serve all areas in Trinidad and Tobago.

The continuation of cataract surgery to decrease the backlog of patients waiting for this special surgery.

The implementation of a National Screening Programme for cervical and breast cancer.

The completion of the Obstetrics, Urology and Neonatal Theatres at the San Fernando General Hospital.

The continuation of training programmes for all categories of staff and those aspiring to join the Health Sector as outlined in our Training Plan.

To commence the construction of the Scarborough Hospital as well as the new Point Fortin Area Hospital.

To complete the refurbishment and construction works on most of our Primary Health Centres.

To open three more wards at the Eric Williams Medical Sciences Complex.

In addition, each RHA has priority service delivery programmes which are being implemented to bring better health care to every citizen of Trinidad and Tobago.

Why has the Government of Trinidad and Tobago adopted health sector reform?
Although there have been many gains in the nation’s health status over the past two decades our health care system has been plagued with inefficiency; poor service delivery; escalating costs; cramped, dilapidated hospitals; closed or run-down health centres with old and unreliable equipment. Chronic diseases including heart disease, cerebrovascular disease and cancer, injuries and accidents, diabetes and hypertension now kill and debilitate large numbers of our population. These diseases can be avoided by changes in individual lifestyle and health practices. Drastic changes were needed in the delivery of our health care services to ensure long-term, cost-effective health improvements for all citizens of Trinidad and Tobago. The mission of the Health Sector Reform Programme is to improve the health status of the people of Trinidad and Tobago by promoting wellness and providing quality health care in an efficient, equitable and sustainable manner.

Is there any role for the private sector in the reorganisation of the health system?
Neither the reorganised Ministry of Health (as purchaser of services or contracting agent) nor the regions (as providers of services) seek to undertake directly all the services they are responsible for they are now able to commission others to provide them. Under the HSRP the Ministry and the RHAs sub-contract services from the private sector, research organisations, training institutions and non-governmental organisations. RHAs and the MOH are free to acquire services from wherever they can obtain the best combination of quality and cost for equipment maintenance and supplies, for example, as well as for clinical services from independent physicians and others.

What are some of the major health problems now afflicting our people?
A longer life span and an increasingly sedentary lifestyle have led to an increase in chronic diseases such as diabetes and hypertension. The arrival of HIV and AIDS and increased substance abuse are seriously impacting on our people. Heart disease is the highest-ranking cause of death in Trinidad and Tobago. Cancer has been the second ranking cause of mortality since 1987 with a rate of 82.6 per 100,000 population in 1990. Cancer is the number one cause of loss of life before age 65 in females because of the earlier age of onset for cervical and breast cancer. We also have a high prevalence rate of diabetes (13% in the 35+ age groups). Well over 90% of diabetes in Trinidad is non-insulin dependent. Research studies indicate that early obesity is the avoidable risk factor which needs to be mitigated if incidence is to be reduced.

What is the Government doing to curb the incidence of HIV/AIDS in T&T?
Between 1983 and 1999 a total of 8,250 HIV/AIDS cases have been reported. Of these one seventh or 1,155 cases were detected in 1999 alone (National Surveillance Unit/Trinidad and Tobago Public Health Laboratory). The actual number may be twice as high due to suspected underreporting. Based on surveys recently started among pregnant women it is estimated that at least 2.5% of the sexually active population (15-49) are living with HIV/AIDS in this country. The AIDS epidemic is not confined to any specific group but has penetrated the general population. Over 50% of new infections are occurring in young people aged 15-24 years and 70% of AIDS cases are in the age group 15-44. We are attacking the AIDS problem in a holistic manner. We are promoting peer education and counselling programmes aimed at both youths and parents. We are enhancing the capabilities of the National Aids Programme to respond to programme demands. We are encouraging religious groups, the private sector and non-governmental organisations to participate in the national response. At the service delivery level we are implementing the reduction of perinatal transmission of HIV programme. We will also be implementing a post exposure prophylaxis policy in all health facilities nationwide.

Is it likely that the HIV vaccine will cause AIDS?
No – highly unlikely. According to the scientific data available this is highly unlikely. This conclusion is based on the use of the vaccine in the USA and France, also by the theoretical underpinnings of the vaccine, which is based on well-proven scientific principles. There is concern that altering the genetic composition of the Canary Pox may also alter its ability to mutate and cause infection in man. The likelihood is unknown but previous research suggests that this is unlikely.

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