Health Sector Reform Programme of Trinidad

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

Feature address of The Honourable Patrick Manning, Prime Minister of the Republic of Trinidad and Tobago

Chairman and Permanent Secretary; Minster of Health, Honourable Colm Imbert; Secretary for Health and Social Services, Tobago House of Assembly, Mrs. Cynthia Alfred; Country Representative of the Pan American Health Organization, Dr. Reneau-Vernon; Representative of the Inter American Development Bank, Mr. John Yates; Chairmen of the Regional Health Authorities; Senior Officers of the Ministries of Health, Social Development, Finance and Planning; Representative of professional associations, Trade Unions, Religious Organisations, Consumer Organisations, Non-Governmental and Community Based Organisations; Consumers of health care, other distinguished guests, ladies and gentlemen.

It is with a sense of optimism that I address you this morning – at this, the country’s first National Consultation to be convened on the health sector since my Government demitted office in 1995.

This event is an indication of the priority my Government has placed on the health sector, within the context of our national agenda.

Ladies and gentlemen, the end of the twentieth century has seen major changes in the patterns and causes of illnesses and mortality.

There have been, for example, major shifts in the causes of death, in respect of both infectious diseases and chronic non-communicable diseases.

Globally, these alterations have naturally produced variations in the epidemiological profiles that now require specific and focused responses, as well as major health policy decisions.

Governments and nations worldwide have been left with no real choice other than to satisfactorily alter their approaches, in effort to keep on top of, or modify and control health risk determinants – including environmental factors, and behavioral and lifestyles choices of members of their societies.

By way of example, in addition to traditional health concerns, the world must now cope with the new challenges brought about by the HIV/AIDS epidemic, as well as problems emerging from increasing violence, inclusive of bio-terrorism.

There are also health risks associated with environmental hazards, some related to developmental processes themselves.

Outside of these, new and re-emerging strains of old diseases have been causes of additional unease.

New strains of diseases and disorders, and new social responses to health problems, old and new, require states, including ours, to focus on restructuring the framework of operations of their health sector, in the light of new international developments, concerns, requirements, standards and experiences of reforms.

Indeed, herein Trinidad and Tobago, these challenges are of necessarily poised against a background of political and economic reforms; for example, the increasing decentralization of our health services, an aspect critical to our health sector reform process.

There is and always will be cost considerations; for example, the challenge of cost effective reforms and the overall cost of making proper and adequate health care more accessible to all, including the small man, in the short and medium term.

Still, the fact remains that health systems the world over are being e-examined, reformed and overhauled.

And, in Trinidad and Tobago, we must fall in line.

Generally, the current trend is towards improving the health status of the population, fostering along the way, increasing participation of various sectors in the planning, implementation and evaluation of public policies that benefit health.

The international experience is that reforms do not work if the stakeholders are for the most part alien to the process.

Among other things, it may very well be that stakeholders must be able to ventilate the dissatisfaction, so as to engage the reform process at the level of deliverables in the most tangible of ways.

And so today, ladies and gentlemen, in Trinidad and Tobago the question of health reform is fully upon us.

In point of fact, it is a question long overdue.

Recall that in May 1993, my Government had commissioned studies aimed at assessing and defining the health sector requirements of our population.

The Report and recommendations received in consequence in 1994, led us into taking the decision for extensive reform of the Health Sector, in order to improve the quality of service to, and the health status of the nation.

As we saw it then, the required Health Sector Reform rested on three interrelated dimensions: health service reorganisation, quality improvement in service, and health service financing.

At the time, nearly all the progressive economies across the world were adopting an egalitarian position with respect to the organisation of their health services, and were attempting to distribute health care according to needs, in an effort to ensure that both vertical and horizontal equity requirements were met.

The prevailing approach regarding the financing of services held that in order to ensure equity, there should be two tracks for funding health service delivery.

In essence, those services that were essentially public goods were to be financed from the public purse, while more individualized services with low externalities were to entertain private financing.

In order to preserve equity and fulfill our responsibility in respect of the delivery of public goods, the Government opted to provide a basic package of services to all our citizens.

In this regard we also examined the option of introducing a national health insurance scheme.

Ladies and gentlemen, you would recall that circumstances changed and we were out of Government for the past six (6) years.

In the past six months, however, we have been re-examining the Health Sector Reform Programme and the changing epidemiological profile.

The situation we met was nothing short of volatile, and it became clear to us that a backlog of problems had conspired to preclude the satisfactory development of the sector.

Ladies and gentlemen, the health sector is a dynamic sector.

For example, new and emerging challenges, including the acute shortage of certain health professionals such as nurses and therapeutic radiographers -–to name a few – have been impacting unfavorably on the achievement of certain benchmarks.

My government has been working on, and is committed to reducing, even ridding our country of, where possible, the problems in the health sector.

And so, it is against this background, that we deem it necessary to convene this national forum on health.

The objective is to dialogue with you, the key stakeholders, in order to shape new priorities for the way forward.

In you deliberations, I ask you to explore fully the issues related to the retention of health professionals in our public health institutions.

I must tell you that, in order to address some of the shortages in the sector, my Government has been holding exploratory discussions with countries within the region.

As some of you might be aware, there is a decision of the CARICOM Heads in respect of the movement of skilled nationals.

And this has led to the institution of certain structures, aimed at facilitating the portability and mobility of skilled personnel.

I take the opportunity today, on behalf of my Government and the people of Trinidad and Tobago, to express sincere thanks to those health professionals who have taken the important decision to remain in this country and support our health sector, notwithstanding its many challenges.

In today’s world, the evolving concept of health as an aspect of human development is based primarily on the assessment of what we may wish to speak of broadly as “population’s health and its determinants.”

The concept of population’s health itself, is basically at the foundation of public health initiatives, and is something that those who labour in the field struggle everyday to ensure and improve.

If gains are to be made in this regard, it is imperative that we improve our capacity to understand, measure and monitor the complex dynamic of population health.

The evidence has been that population health itself is far less responsive to the usual medicinal care intervention, than the changes in the physical and social environment.

In this regard, my Government will fully support the development of a National Surveillance System.

And we will go the full distance, inclusive of building the institutional capacity for implementing such a system, as well as the introduction of information technology required to drive and support the system.

Put another way, ladies and gentlemen, in so doing, we will be developing our capability to establish reliable systems for the analysis of health status measures at all and any levels, so as to facilitate improved programming, monitoring and evaluation of our nation health programmes.

By extensions, and of critical importance, we will be able to provide increasingly precise definitions of our health sector priorities, now and in the future.

This will result, among other things, in efficiency in the adjusting or re-directing of our health policies, as the case might be, and in greater accountability and better value for money from the public purse.

The health of our nation, or rather our population’s health, is too important.

It is in fact most important, and therefore cannot any longer be left to speculations and “guesstimations” in any way, and at any level.

We must know how to plan. We must plan because we know. And we must know that what we have planned will work.

This must be so in respect of our manpower needs, machinery and plant, medicine, diagnoses and prophylaxes, and the whole range of epidemiological concerns – from needles to beds, from in-patient to out-patient care, from training to employment, from pediatric to geriatric services ---

Within the limits of practically, it matters not what it is, ladies and gentlemen: all aspects – indeed nothing in health – including workers’ satisfaction, must be left to unwarranted chance.

Chance is a risk we can no longer afford.

In today’s day and age, we have to get beyond that stage. And in health, as in every thing else, knowledge is power.

And it is this knowledge that must inform our health sector reforms and the operation of our health sector. On the one hand, population health is bye-product of society. A population’s level of health is in itself an excellent indicator of its level of human development.

In recognition of all these relationships, the Ministry of Health has the support of my Government in creating and strengthening partnerships with other public and private stakeholders, including non-governmental and community-based organizations interested in the formulation of policies and programmes that will promote our nation’s well being.

One such initiative involving different sectors, and currently in train is the development of a National Strategic Plan on HIV/AIDS.

The object is to address the increasing incidence of this disease, with its potentially devastating impact on our human and social development.

You should know, ladies and gentlemen, that already my government is putting into place the pre-requisites for the introduction of a far-reaching and comprehensive programme for the treatment of persons with HIV/AIDS.

Yet another example of the partnership approach of which I speak, involves a Government to Government initiative aimed at addressing the situation with respect to cancer, one of leading causes of mortality in our country.

My Government has entered into an agreement with the Government of Canada for the establishment of a National Oncology Centre for Trinidad and Tobago.

The project will be fully activated within the next two (2) months, and our expectation is that the Centre will be full operational in two (2) years.

In the interim, we will continue to maintain the National Radiotherapy Centre at St. James, but at a more appropriate level.

A new Cobalt machine has been installed, and the staff has been complemented with an additional twelve (12) nurses who have completed post-graduate study in Oncology Nursing at Mc Masters University.

Ladies and gentlemen, matters relating to the construction of the Scarborough Hospital are also receiving priority attention at this time.

Works for outfitting the new surgical ward, a day surgery and ambulatory care units at the San Fernando General Hospital are imminent.

Impending also, is the award of a contract for the designs of the Point Fortin Hospital.

All this apart, the Ministry of Health will soon be issuing Accreditation Standards for the Health Sector.

We must get our standards right, and moving upwards.

There must be no choice in that matter.

And so, the Ministry will be launching a health Sector Quality Awards programme to mobilize towards that end.

I ell you all of this, ladies and gentlemen, so that you will understand my government’s vision for a health service that is comparable to the best anywhere in the global village.

Out citizens deserve the best. They must seek and we must provide no less.

In this regard, my Government fully commits itself to the Nassau Declaration on Health 2001, which recognized that “The Health of the Region is the wealth of the Region”.

Permit me to quote from the CARICOM Heads declaration, in this respect. I quote:

“We (meaning CARICOM governments) commit ourselves to the pursuit of initiatives and targets to be implemented to achieve an improved health status of our populations within the next five (5) years, emphasizing leadership, strategic planning, management, implementation and resource mobilisation in the context of health sector reform processes that are underway”.

Ladies and gentlemen, Health is an essential pre-condition without which people cannot lead normal lives, not to mention work and produce effectively.

The distinguished Karl Popper, in his treatise entitles “Search for Social Justice and for a New World” has written:

“Man has created new worlds of language, of music, of poverty, of science; (but) the most important of these is the world of moral demands for equality… and for helping the weak”.

Illnesses and death levels man to equality.

Because all are susceptible, there is a moral compunction that the well will heal the sick and the strong will help the weak.

This, ladies and gentlemen, is our commitment to the inviolability and sanctity of human life.

There exist no more important avenue for extending such commitment, care and concern than when, in conditions of debility and incapacity, men deliver themselves into the hands of brethren, trusting to be done all that will preserve their life and limb.

Ladies and gentlemen, the nation must trust us to look to their health interest.

As we go to these deliberations, let that trust which the nation must repose be in our minds, and let the health of our population be foremost in our thinking and talks.

I thank you for your attention, wish participants all success in their deliberations, and look forward to the conclusions.

May God bless us all.

I now declare this Consultation formally open.

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