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

Trinidad & Tobago Manufacturers' Association

T&TMA wishes to congratulate the Minister of Health and his team for arranging this National Consultation instead of having high-priced foreign professionals to tell us what is wrong with the Public Health Sector and how to fix it.

Health Sector Reform

In 1994 the Government of the Republic of Trinidad & Tobago (GORTT) passed the Regional Health Authorities Act which established five Regional Health Authorities (RHAs). This launched what was supposed to be a restructuring and reformation of the delivery of Health care in this country.

Eight years on, while some restructuring has taken place very little reformation has occurred.

In earlier consultations the T&TMA had advocated the setting up of Hospital Boards to run the major Institutions, as it was felt the centralized management of Hospitals by the Ministry of Health was contributing to the inefficiencies of the Service. The Government decided however to seek the advice of HLSP who after allegedly consulting all the stakeholders came out with its “Blue Book”. It recommended the establishment of 5 RHA’s. During its infrequent meetings with HLSP, T&TMA had, on realizing the direction being taken advised the setting up of two RHA’s in Trinidad and one in Tobago. These would be based on the POSGH in the North, SFGH in the South and Scarborough Regional in Tobago. HLSP ignored this and went for five. Today four survive and Eastern has had to borrow services from North and South.

A fatal assumption made was that all staff who were Public servants would automatically transfer, second or join the RHAs. This never happened and eight years later the senior doctors still remain under the employ of the Ministry of Health.

There is in fact a dichotomy of authority with all the junior doctors employed by the RHAs. The incongruity of the situation is that the head of every unit in the Health service is employed by one authority but works in premises run by another. That there has not been a major disaster speaks volumes for the goodwill that the doctors (and nurses) have provided to prop up the Health Services.

The parallel systems have led to the establishment of parallel administrative systems to deal with the two classes of staff. A duplication, in many cases, of administrative staff now exists. The RHAs went overboard in setting up their administrative structure. Managerial posts were created everywhere and anywhere. Managers with little or no experience in Health care systems were hired on an ad-hoc basis. The resultant top-heavy RHA administration has resulted in the RHA budget being skewed to the tune of 78% of its annual Budget for funding personnel and 10% for goods and services. Thus while the IADB has been pushing for a Primary Health Care slant to Health reform the Rheas have been left with little to channel to the community. At the same time the per capita expenditure on health has declined yearly (TT%667 in 1982 to TT$279 in 1992).

The T&TMA recommends that the following should be done:-

1. Reduce the number of RHAs to a maximum of three – North, South and Tobago

2. Bring all health sector workers under one Authority. If necessary buy out the services of all and rehire.

3. Trim down the administrative managers. A comprehensive audit of RHA organizational structures must be done and redundant posts eliminated.

4. Contract out services that do not now exist in the Public domain e.g. MRI, laser treatments, open heart surgery etc that would be too costly to install and run. The public Institutions are notorious for equipment failure and long down time. This rarely occurs in the Private sectors. Strategic partnerships would benefit both the RHAs and the providers. Preferential rates in exchange for a larger volume for the provider.

5. Carry out performance audits of medical and non-medical staff. Provide performance incentives, bonuses and yearly increments based on these appraisals.

6. Eliminate the exodus of health professionals by revising their remuneration packages to match first world standards.

7. Expenditure on Health from the present 2.9% GDP to match USA 13.7% or Canada 8.62%, UK 5.8% or Zimbabwe 6.2%.

8. Negotiate a proper Pension Plan with equal contributions from employee and employer to the satisfaction of all stakeholders.

Whatever reforms are done, do it in small doses and in conjunction with available resources.

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