The noble goal of universal access to healthcare by all Bahamians is being challenged by several stakeholders not based on the principle, but rather on the premise of how the government plans to achieve this through the proposed National Health Insurance (NHI) scheme.
The coalition is of the view that a life lost due to the lack of access to quality healthcare in The Bahamas is one life too many. The government therefore has the obligation and significant role in assisting those among us who are unable to fend for themselves.

The main contention is that the elaborate plan as contained in the hundreds of pages of the report produced by Sanigest Internacional - the government's consultant from Costa Rica - seems to outline the framework for an initiative that is not only unaffordable but also not sustainable. Additionally, the proposal also appears to alienate the important allies and partners that are required to achieve this national initiative. It is difficult to understand why the current administration is trying its best to fail at bringing about an initiative as important as universal health coverage by adopting a wrong approach and picking fights with groups that do not oppose the essence of their plan.

Outside of the debate on NHI, we examine the genuineness of the government's commitment to universal healthcare for the people of The Bahamas. Without getting into the extensive details from Sanigest, there are some basic things that could have been and can still be done to create a healthier Bahamas and achieve better health outcomes for all of our people.

Nutrition and the cost of healthy foods
It has been said over and over again that our diet as Bahamians is generally not very healthy. A look at the typical meal during lunch hour will show that we do not do a superb job in consuming a balanced diet. While it is recommended that individuals consume more fruits and vegetables, our meals are often dominated by starch and proteins with significant proportion of fats.

The truth of the matter is that it is not cheap to eat heathy and individuals with the best intentions regarding consumption of healthy foods are quickly brought back to reality when they visit the grocery store. Simply put, very few Bahamians can afford to buy the right quantity of fruits and vegetables necessary to stay healthy. Sadly, despite the outcry from the masses, the government has not deemed it necessary to provide incentives for healthy nutrition by significantly reducing the taxes on organic foods as well as fruits and vegetables.

This is in spite of the fact that they could recoup some of the lost revenue by increasing taxes on processed foods and unhealthy food items. This raises the important question: How much does the government care about our health? Perhaps the minister of finance, the minister of state for finance and the minister of health can answer this question.

The health of Bahamian youth and children
The rate of obesity and number of overweight persons in The Bahamas is cause for concern as is the case with diabetes. More disturbing, however, is the rising number of our children who are not only overweight but also obese and often have diabetes. It is apparent that the main cause of this phenomenon is their diet and an inactive lifestyle fostered by minimal physical activity.

We are not privy to any deliberate effort or initiative by the government to confront this menace either by regulating the lunch menus of food vendors at our schools, launching programs to educate children, parents and guardians or simply working with the private sector to promote physical activity among school children. The children of our country are the future of our country; we have a duty to keep them healthy to ensure the continued progress of our nation. Is anyone out there listening? The minister of education and minister of Social Services, and again the minister of health, come to mind.

The cost of healthcare in The Bahamas
It has been reported that the cost of healthcare is much higher in The Bahamas than it is in other countries within our region. When this is considered against the returns and outcomes, it is obvious that something needs to be done to make healthcare more affordable in our country. This is an area where there also seems to be agreement by basically all persons involved in the NHI debate. The million-dollar question is what has been done and what is being done to address this issue seeing that one of the main objectives is to ensure that the lack of sufficient money is not a barrier to healthcare access.

For decades, we have complained about the rising cost of healthcare and how it is putting healthcare beyond the reach of the average Bahamian. However, the status quo has remained and insurers have attributed the rising health insurance premiums to the increasing cost of healthcare. Sanigest, like previous consultants and local commentators, has proposed certain ideas to drive down these costs even though this has only come about as part of the NHI public discourse. What has the government been doing and what will the government do to reduce the cost of healthcare for Bahamians, which has consistently been increasing for the past 20 years? This seems to be a question best suited for the minister of health.

Despite the above, the government made the unpopular decision to impose value-added tax (VAT) on healthcare and health insurance premiums. Most jurisdictions across the world do not impose such taxes on healthcare because they serve as an impediment to access by the people of the country. Charging VAT on the cost of visiting clinics, doctors, laboratories, therapists and imaging centers, just to mention a few, effectively makes those services more expensive for the Bahamian people effective July 1, 2015. Is this the action of a caring government touting its concern for universal access to medical coverage in The Bahamas?

To add insult upon injury, individuals who are currently able to afford health insurance or make sacrifices to purchase health insurance will be required to pay an additional 7.5 percent on their health insurance premiums beginning July 1, 2015. This does not include any increase that health insurance companies may add to their existing insurance premiums. It is difficult to reconcile these actions by the government to that of an administration or political leaders who genuinely care about the health of their people or who are committed to ensuring that more people can access and afford healthcare in The Bahamas. This contradiction can only be explained by the minister of finance, minister of state for finance and minister of health (who ought to have been an advocate for the health sector).

Healthcare infrastructure
The state of public health facilities in The Bahamas has been a recurrent topic in all studies done on universal healthcare for over 30 years. The evidence is right before our very eyes and our people are confronted with this on a daily basis as they visit Princess Margaret Hospital and other public clinics. They are in a deplorable state and the blame lies at the feet of successive governments of The Bahamas.

This government has had more than one opportunity to fix it and they have not. One of the main issues has been the poor culture of maintenance and improvements to these healthcare facilities as well as the shortage of resources. The Sanigest report attests to this by indicating that persons on the public ward at PMH are more than five times more likely to die than those on the private wards.

This is sad and unacceptable. The government's proposal for NHI will still not fix this problem. The culture of waste and corruption has to be solved.

There has been much talk about the new Critical Care Block; however, the infrastructural needs are more extensive than one building. Upgrades to our community clinics in the form of equipment and human resources are necessary as we begin our journey to universal healthcare in The Bahamas.

Where is the care or concern?
Universal health coverage is a massive project that often takes years to be actualized in any nation. There is a popular saying that the journey of a thousand miles begins with one step. Journeys are indeed made up of steps and the points made in this article are specific steps that demonstrate dedication to our well-being by the government. Regrettably, we have seen very little progress on these minor but important initiatives by the proponents of NHI for the past three decades.

The various areas touched by a comprehensive health reform process show that a holistic approach involving several ministries, government agencies and other stakeholders must be adopted to make universal health coverage a reality in The Bahamas. As the government prepares to commence debate on its 2015/2016 budget, the coalition will be watching to see whether the government cares as much as its members profess.

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