Health Sector Reform Programme of Trinidad

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

The National Union

Of Government and Federated Workers

1. INTRODUCTION

1.1. This Paper from the National Union of Government and Federated Workers has been written for presentation at the National Consultation Form on the Health Sector, which is being held at the Trinidad Hilton Hotel Conference Centre on 5^th and 6^th August 2002.

1.2. The main purpose of the Forum is:

“… to provide an opportunity for key stakeholders to participate in revitalising the consultative process with a view to arriving at consensus on the general principles that will inform the way forward for the health sector.”

1.3. This paper from the NUGFW is designed to respond to this agenda.

1.4. The central principle on which the NUGFW approaches health care for the people of Trinidad and Tobago is that it should be based on providing the best health available free at the point of delivery.

1.5. Only by taking this approach can we ensure that we do not develop a two –tier health service.

1.6. It is also important to ensure that clinical requirements, rather than financial considerations, are the prime factor in determining health care provision.

2. A HOLISTIC APPROACH

2.1. It is important to take a holistic view of health care. This means:

2.1.1. Ensuring that there are accurate statistics available on the health of the nation

2.1.2. Providing running water and proper sewage systems to the whole of the country

2.1.3. Ensuring that the Insect Vector Control Department of the Ministry of Health is properly staffed, trained and equipped to a level capable of carrying out its task

2.1.4. Taking the necessary steps to increase road safety

2.1.5. Addressing lifestyle issues such as exercise, eating habits, safe sex, safe legal methods for termination of pregnancies, adequate education and facilities dealing with sexual health and family planning, substance abuse, domestic violence, smoking and sexual abuse

2.1.6. Providing permanent sustainable jobs which will help to eradicate poverty, reduce crime and reliance on drugs and drug trafficking

2.1.7. Establishing an effective occupational safety and health – a first step of which would be to pass the Occupational Safety and Health Bill

2.2. In simple terms, we cannot separate health care from what happens in the rest of our society.

3. PREVENTATIVE HEALTH CARE

3.1. The reason for emphasising a holistic approach to health care is that it is cheaper, in the long run, to avoid illnesses and accidents. More importantly, it also adds to the quality of life.

3.2. Linked to this approach is the need for preventative health care. This means putting in place reliable screening for preventable and controllable illnesses and diseases such as:

Diabetes
Sickle cell anaemia
Prostate cancer
Breast cancer
Cancer of the cervix
Obesity
Hypertension
Stress
Cardio vascular problems

3.3. This screening needs to be done at local level on a regular organised basis. This means having an effective network of properly staffed and equipped clinic in all communities

3.4. There also needs to be the means to treat any problems identified during any screening process.

4. PRIMARY HEALTH CARE

4.1. We need to develop and upgrade our community based primary health care services.

4.2. Most medical situations require routine medical and/or nursing attention rather than major high-tech hospitals. What is important in these circumstances is for quick, easy and local access to medical assistance.

4.3. We need clinics in all localities in easy reach of all local communities, which would have basic healthcare facilities and staffed by qualified medical and nursing personnel.

5. REGIONAL MEDICAL FACILITIES

5.1. Access to the next level of medical services, with facilities such as x-ray, CT scan and minor surgical facilities, should be provided in a way that would enable referrals from primary health care facilities quickly and easily. This means having regional medical facilities in all major populations areas.

6. MAJOR MEDICAL FACILITIES

6.1. Specialist medical services, such as cardiac care, cancer care and other specialist major trauma centres, need to be strategically located throughout the country

6.2. We should identify the gaps in our health care provision and take immediate steps to ensure an effective and broad based service covering all illnesses.

6.3. Such weaknesses might include such areas as kidney dialysis and kidney transplants.

7. TOBAGO

7.1. Special attention needs to be given to Tobago to ensure that people have proper access to the full range of health services.

7.2. Whilst the provision of primary health care and regional services can be located in Tobago, it is important to ensure that there is proper access to specialist facilities than might only be available in Trinidad.

7.3. Consideration needs to be given to the introduction of an emergency air ambulance to provide a vital link between Tobago and Trinidad.

7.4. This should be the responsibility of the EHS but the actual air ambulance might be provided by some other part of the protective services such as the Defence Force of Coast Guard who might already have helicopters available that could be utilised.

8. EMERGENCY HEALTH SERVICE

8.1. One of the major success stories is the introduction of the Emergency Health Services.

8.2. It is important that it is not only maintained but also strengthened. This means ensuring adequate funding, proper training to ensure standards are maintained and adequate machinery to maintain the vehicle fleet.

8.3. Standards should be monitored by the use of percentiles and new ambulance stations introduced where necessary to ensure improved response times.

8.4. Whether it is 999 or 911, there should be a single emergency service telephone number for Fire, Police, Ambulance and Coastguard.

9. MENTAL HEALTH

9.1. There are too many people with psychiatric problems walking our streets.

9.2. If we are going to have a community mental health service then it must mean more than just setting patients loose. There must be proper services in the community to ensure medication, rehabilitation and other services are not only available but that there is proper follow-up and monitoring where necessary.

10. AN INTEGRATED SERVICE

10.1. With the development of four Regional Health Authorities, it is important that there are not four totally separate uncoordinated health services.

10.2. If RHA’s are to be the providers of direct health services, the Ministry of Health needs to ensure it is not just a facilitator but an overall planner and co-coordinator of services too.

10.3. This is particularly important when it comes to planning the location of regional and major healthcare facilities.

11. STAFFING ISSUES

11.1. Of all public services, health care will always be labour intensive. There can be no excuse for not addressing industrial relations issues properly and this has clearly been a major problem area since the introduction of the RHA’s in 1994.

11.2. There must be trade union recognition for all health service workers employed in RHA’s together with a serious commitment to providing proper pay and conditions of employment.

11.3. Our health services cannot constantly be faced with staffing crises caused by the loss of skilled personnel. A satisfactory “employment package” needs to cover not only reasonable pay and conditions, but also opportunities for training, re-training and improvement in skills and standards.

12. EQUIPMENT AND TRAINING

12.1. One of the major complaints from medical staff during the industrial action several years ago was the lack of equipment and training.

12.2. We suspect that this has not improved to any acceptable level and poor and inadequate equipment not only inhibits effective health care provision but also leads to low moral amongst staff.

13. THE PRIVATE SECTOR

13.1. The private sector will develop in direct response to the inadequacies of the public health care system. The development of Medical Plans, which reimburse medical expenses, encourages the growth of private health care.

13.2. From work done by the NUGFW in negotiating its Medical Plan for Government daily rated workers, the largest Medical Plan in the country, it was clear that as much as 32% of contributions collected would be lost in administrative costs and profits if an insured plan had been used. By having a self-administered Plan as much as 25% was available to be re-directed to the benefit of the Plan members.

13.3. The burden of administration that accompanies insurance-based plans can often be excessive. We need to ensure that Trinidad and Tobago does not slide into the worst aspects of the American model.

13.4. Similar profits are made from private clinics, which only add to the overall costs of health care provision in the country.

13.5. If health care facilities outside the public health service are to be encouraged, they should be non-profit making, co-operative based which supplement and not detract from a countrywide integrated public national health service.

14. FUNDING

14.1. Without adequate funding, no health service can survive.

14.2. It is important to ensure that a higher level of our Gross National Product is allocated to our health service.

14.3. We should examine whether the administrative cost of the Health Surcharge makes it collection efficient. The money goes directly into the Consolidated Fund and it is essentially just another tax.

14.4. It might be better just to allocate increased resources from the Consolidated Fund. If there is the need to raise more in the way of taxes, we should increase taxes on profits to fund our health service.

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