With the implementation date for National Health Insurance (NHI) fast approaching, the debate on NHI continues. The discourse around such a significant program as universal health coverage (UHC) for our people should focus on the issues and facts that have been brought to light by the government and the various stakeholders.
According to the government, we are now exactly one month away from the implementation of NHI in The Bahamas. When one bears in mind the fact that we are heading into the holiday season, we really don't have one month before the launch of NHI. That being said and with the clock ticking, it is obvious that the various stakeholders and the government are still not on the same page. We are still unsure as to what NHI is and it is unclear to the average Bahamian what we can expect in 2016.
Support for UHC
In a previous article, this writer had implored the government not to squander the support of UHC as proclaimed by all stakeholders. That piece also cautioned against a false perception by the government that the skills, expertise, infrastructure and resources required for the successful implementation of UHC and by extension NHI were not solely concentrated in the public sector or government agencies.
The students at the College of The Bahamas should be commended for taking an interest in the national debate around UHC in our country. It is noteworthy to state that some of the results of their survey are consistent with what many believe is the general sentiment on UHC and by consequence a proposed NHI scheme. More specifically, it was reported that over 70 per cent of participants support the implementation of NHI.
In essence, the question does not appear to be whether anyone wants or opposes UHC; rather the discussion has focused on how much the expansion of UHC will cost, particularly NHI and how will it be implemented, what will beneficiaries get in the form of service as a result of NHI as currently proposed by the government and can our existing infrastructure enable us to successfully launch this program in its entirety on January 1, 2016?
Politics and our health
As we have come to expect on almost every issue of national importance, politics has been brought into a vital discussion on the health of our people. Political organizations have been seeking to gain brownie points by making statement after statement in an effort to either justify the scheme as proposed or discrediting the initiative. We have become so distracted by this wrangling that the key issues have been ignored or swept under the proverbial carpet.
Politicians in The Bahamas should be reminded that when it comes to the health of our people, politics should take the back seat and logic should prevail. They should be guided by the principle that when they have nothing of substance to add to a debate, it would serve them well to say nothing rather than further fuel unnecessary strife and ignorance among our people. More importantly, alternative solutions should be put to the fore for the best result as it is patently clear that there is obvious support for the implementation of NHI among the populace.
The message is clear: we should not be playing political football with UHC and by extension our health. Then there is also the politics of the various stakeholders, particularly those unknown and in some cases without a face. Why all the confusion about NHI? Over and above the recipients of healthcare, who stands to benefit financially from its implementation and who stands to lose as a result?
Certain stakeholders have been very transparent and have publicly declared what they stand to lose; these include reduction of revenue, reduction in the quality of healthcare services, increased risk of job losses and reduction of benefits among other things.
The mystery of NHI
One of the main concerns of the Bahamian people has been the lack of adequate information on what they can expect with the introduction of NHI. It would be an understatement to say that the public education and awareness on this initiative has been inadequate.
In fairness to the government and persons overseeing this scheme, it has been reported that nothing has been finalized and discussions with stakeholders are ongoing. Hence, it would seem premature to educate the people on something that is either unknown or subject to change. However, there is so much that can be done in the interim while they seek to work out the details as the implementation date fast approaches.
We have seen a few advertisements and infomercials on what the government is doing or trying to do to strengthen the existing public health infrastructure. The reality is that these efforts are just inadequate when the magnitude of UHC is considered in the Bahamian context.
What are we doing about the promotion of healthy living, which can impact the cost of healthcare? Do we plan to have a national wellness program upon implementation? What will be done to encourage a more healthy diet among Bahamians? Does the government plan to make fruits, vegetables and organic foods more affordable by reducing or eliminating the taxes on them?
Is there a program in place to ensure that persons embrace preventive care, wellness checks and annual check-ups? What are the various phases of NHI and what are the applicable timelines? What can we expect during each phase and what benefits will be provided?
Then we have the elephant in the room: how much will such initiatives cost us and how will we be paying for this vital program? While it appears that the principle of UHC is supported by everyone, it would seem unfair to expect unequivocal and blind support for the NHI model being proposed without answers to these pertinent questions.
Consultation and consultants
The Bahamian people are becoming weary of the words "consultation" and "consultants" as far as the discussion on NHI is concerned. There seems to be a misunderstanding as to what constitutes consultation and the level of subjectivity in this regard makes it even more difficult to reach a consensus on whether this is taking place. However, as the prime minister put it, the main point here is that there ought to be meaningful consultation; this suggests that each party has a voice or opinion that is genuinely considered in arriving at the final position - including the consumer who should be empowered with the relevant information to actually engage in the dialogue.
How difficult is it to ensure that this is done in relation to NHI? While it is unrealistic to expect all parties to agree on everything and it is unfeasible to anticipate that all suggestions will be embraced, we should be able to arrive at a position that everyone can live with.
While this writer sees the value in and importance of engaging consultants to assist with various projects when the need arises, the bigger issue is what we do with the findings and recommendations of all these reports. Having paid significant amounts of money (sometimes at the expense of taxpayers), it is imperative that the reports are shared with the populace and the recommendations are implemented. There is no doubt that had we implemented all the recommendations aimed at improving our healthcare system over the past decades, the partial UHC system we currently have would have been further ahead.
What happens in 2016?
There is no doubt that time is of the essence as we are fast approaching January 2016 and the launch of NHI in The Bahamas. The government has stated that the timeline for rolling out the scheme remains unchanged and in spite of some challenges, the intention is to proceed as planned. If this is in fact the case, it would be helpful for the government to immediately enhance the education of the Bahamian people.
The position taken on all reports and recommendations provided by the government's consultants and advisers should also be communicated. Additionally, stakeholders should be advised whether there is any room or appetite for the meaningful consultation they have been clamoring for. In the final analysis, the following fundamental question should be answered: What happens in 2016? In communicating the details of its plans for NHI in the coming year, the government will do well to manage the expectations of the people and provide clear information on what will and will not happen. We owe that much to the Bahamian people.
o Arinthia S. Komolafe is an attorney-at-law. Comments on this article can be directed to a.s.komolafe510@gmail.com.
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