I rise on behalf of the Ministry of Health to make my contribution to this 2010/2011 budget presentation and thank the great constituency of Killarney for the opportunity to present this, my third health budget to this honorable chamber.
I wish to congratulate the Rt. Hon. Prime Minister and Minister of Finance, the Hon. Hubert Alexander Ingraham, for his courage in presenting a Budget that is reflective of the realities of the national economic situation and that refused to defer difficult decisions for future generation of leaders. The 2010/11 Budget sensitized the public to the harsh economic times we are facing and made an urgent and immediate call for sacrifice, service and reform from all citizens. The Prime Minister and his government are leading by example via salary cuts for itself and senior managers in the Public Service.
Today, the government has to provide more services for more people from diminished revenue. Consequently, it is necessary to increase some taxes to fund those increases in services the government has to provide. This government continues to believe that access to health care is a right to be enjoyed by all citizens.
At the Recent World Health Assembly in Geneva Switzerland last month, time and again speakers emphasized the importance of sustaining investments in health. And that is why, although the impact of the financial crisis on health is noted, and the 2010/11 budget imposes necessary fiscal discipline on citizens of this country, priority spending will continue to be given to Health.
In the 2010/11 fiscal period, two hundred and twenty six million twenty three thousand three hundred and seventy six dollars ($223,372,876) or 14.4% of the recurrent budget has been allocated for health services, and health has been identified as one of the three areas for priority spending.
The Rt. Hon Prime Minister in his budget presentation to Parliament and the nation, explained why in the upcoming fiscal period, public resources must be managed more judiciously and prudently within the limits he outlined. He also issued a clarion cry for service excellence and behavioral changes to improve the quality of life for our people.
Before I continue my presentation, I would like to thank the staff of the Ministry of Health, Public Hospital Authority and Public Health who worked tirelessly and diligently in assisting with the compilation of the information that I am about to present. As a Ministry we worked together as one family for we recognize that each and every individual has a role to play and just as important as the other.
I first entered front line politics in 2006 and was subsequently elected as the member of Parliament for Killarney in 2007. This was no easy decision for after returning home in 1985, I was approached by the late Cecil Wallace-Whitfield former leader of the FNM, who was trying at that time to encourage me to become a candidate in 1987. However, at that time I felt that I was not emotionally, psychologically, financially and spiritually ready. This same dilemma presented itself to me in 1992, 1997 and 2002, however in 2007 I felt a burning urge to serve my country.
Before making that final plunge, while travelling home in the company of my last son who was then eleven (11) years old, I sort his opinion on my entering politics. His exact response resonated with me to this day of which I will share with you. He said, he did not like politics, however if I was entering for the right reason then he would support it. I then of course, questioned him as to what the right reasons were. His answer was simply;
1. You must remember that you are there to serve the people and not yourself;
2. You must never become arrogant;
3. You must never feel that you are better than other people;
4. You must never become corrupt;
5. You must always put the people first and
6. You must never try to enrich yourself at the expense of the people.
If you bear these reasons in mind and adhere to them, then I would support you.
I was very moved by those words, the words of an eleven (11) year old, the words of the young, the future generation of our country. All politicians motto should be to prepare and protect the future. I live by those words, and I hope all politicians today and tomorrow to live by these words, because it is only through these principles that our country will progress.
THESE PRINCIPLES ARE THE EXPECTATION OF OUR YOUTH, OUR FUTURE, AND WE SHOULD ALL REFLECT UPON THEM. THIS BUDGET, MR. SPEAKER, PROTECTS THE FUTURE OF THE BAHAMAS. THIS SPEAKS TO THE WORDS UTTERED BY MY THEN ELEVEN (11) YEAR OLD SON.
During the 2010 Mid Year Review, I spoke to the nation of the employment of careful management of resources and improved efficiencies in operations in the public health sector, and I applauded the fact that those efficiencies cost no money but resulted in greater satisfactory service to the public.
As we go through these hard economic times, many people are hurting, our middle class is shrinking, some people are losing their health insurance, their homes, the food supplies are decreasing, the demands upon social services are increasing and many are removing their children from private schools into public schools. The bottom line is that many are suffering and need urgent help.
The greatest cause of bankruptcy and subsequently all of the previously mentioned results is illness (health-related). This can be easily seen when one look at a small business owner that gets ill, this illness causes great financial strain not only on the individual but on the business itself as it may result in foreclosure and subsequent unemployment for employees. This can occur in individuals with or without insurance based on the severity of the illness.
When one review the type of illnesses that leads to bankruptcy, you will find that the chronic non-communicable diseases are among the leading causes. It is my job as Minister of Health to ensure a healthy population and thus protecting against bankruptcy and its sequelae one of my primary goals.
This is demonstrated by a review of Asia’s economic growth between 1965 and 1990, believed to be attributed to direct improvement of their healthcare delivery, systems and industry. This improvement in the healthcare sector can be directly linked to the increase in productivity.
This is why the introduction of our Drug Plan against chronic non-communicable diseases is so important, this plan provides medication for eleven (11) different diseases but most importantly it has a preventative component attached. Patients would be able to obtain their medication from the already registered private pharmacies (Lowes, etc).
The Bahamian public does not want to hear how many clinic roofs I have repaired. How many doors I have replaced, how many new bathrooms I have constructed. How many clinics now have proper maintenance programs, how many doctors I have hired, nurses I have hired, security guards now employed. They do not want to hear that our HIV patients are receiving proper medication in a timely fashion in keeping with the Millennium Development Goals (MDG), or that our surveyance program continues to monitor and contain the tuberculosis infection and/or malaria development. No, Mr. Speaker, the Bahamian people will tell you that this is my job and they are correct. But, what they want to know is;
1. Why when attending the clinics they are forced to wait because the doctor has either left early or arrive late.
2. Why they have to wait to see a dentist because the dentist arrives at 10:00am and leaves at 11:30am.
3. Why while attending the clinic some doctors see only six to ten patients and leave.
4. Why while attending the clinic, after arriving at 8:00am to select a number only to be told no more numbers are being issued after already waiting for three hours.
5. Why clinic managers do not record and enforce accountability.
6. Why supervisors are not being held accountable.
7. Why are patients being turned away.
These are the questions the Bahamian public want to hear answers to, and these are what I will address.
a) Throughout our clinic system, especially in New Providence, we will introduce performance targets for all our staff members; our clerks will be expected to have a specified amount of patient records for our physicians, so that they must see a specified amount of patients.
b) We have had positive discussions with our Public Service Union (BTSU), Nurses Union and Doctors Union concerning the introduction of time clocks within our clinics.
The unions, like us, do not condone non-performance and expect their members to be accountable but at the same time treated fairly.
c) The Department of Public Health should be a client-centered service delivery structure. In conjunction with the Public Services Union, the Ministry of Health will put on a workshop on the industrial agreement for its supervisory and management staff. This year we intend to turn one of the Ministry’s mission statements “to achieve excellence in service through punctuality, productivity and professionalism” more than a slogan. We must be all about the clients we serve and to improve the over all health and well being of the Bahamian people in collaboration with other government agencies and other civil society groups.
(Example – working with BNDA).
d) The Supervisors of the Ministry of Health will soon commence customer service training at University of Atlantis (Sun International) to improve the overall customer service delivery, leadership skills and human resource record keeping/accountability.
THE MINISTRY OF HEALTH
The Public Health sector has embarked on coordinating the preparation of a comprehensive National Health Services Strategic Plan for the next ten years. I should point out, Mr. Speaker, that the last strategic plan for the sector covered the period 2000-2004. The Plan, which focuses on health promotion (wellness) & protection and good health, rather than on disease. The Plan provides for strengthening the capacities of the Ministry staff who have responsibility for the oversight and management of National Health Programmes. External agencies, PAHO and the IDB, are supporting this initiative.
One sub component of the Technical Cooperation Project with the IDB will finance assistance to review existing health regulations to identify issues that may need to be addressed to support achieving the strategic goals defined for the sector. One such goal is a follow-up on enactment of revised legislation drafted to regulate medical laboratories and medical laboratory professionals.
During this Budget period, the health sector will also benefit from assistance under the United States’ President’s Emergency Plan for AIDS Relief (PERFAR), which will strengthen our national response to HIV/AIDS. The assistance will strengthen the capacity of the health sector to scale up the HIV/AIDS strategic information, laboratory support and prevention activities.
I will sign the PEPFAR grant document later this month and thereafter, the grant will provide some $1.6 million available for achieving the goals of PEPFAR in year one of the programme and another $450,000 in years two and three. The objectives of the Ministry under the PEPFAR agreement include HIV prevention, strategic health information strengthening, laboratory strengthening, human capacity strengthening and sustainability of the programme through the strengthening of the Office of the Chief Medical Officer and the planning unit.
The HIV/AIDS Unit
The HIV/AIDS unit continues to perform well. The improved HIV Reference Lab has decreased the turn around time for the availability of CD4 and Viral Load results. There has been an increase in the number of persons who were once lost to follow-up, and who are now requesting CD4 and Viral Load tests. In partnership with the Clinton Foundation, a new Adherence Manager began work at the HIV/AIDS Centre in March 2010, to assist in client compliance with antiretroviral medication.
The Ministry has made good progress in the arrangements for strengthening the HIV/AIDS Reference Lab in the 2010/11 fiscal period. Improved national public and private medical laboratory information leads to improved patient management, disease prevention and control. More will be done under the grant from the Presidents Emergency Relief Plan for HIV/AIDS.
Recruitment, training and retention of nurses are among the top priorities of the Ministry of Health. The Nursing Cadet Programme is the major nursing recruitment strategy in the Ministry of Health. One hundred and twenty-seven (127) senior high school students in New Providence participated in the Nursing Cadet Programme in 2009 and of these 50% went on to the Bachelor’s programme in COB. The Ministry of Health provided 33 scholarships (full tuition plus a stipend) for nursing students at The College of The Bahamas. An additional thirty-one (31) nursing students commenced Internship in May of this year. They are scheduled to sit The Nursing Council’s Final Examination for Registration in November, 2010.
The 17 bonded students at COB pursuing the BSc Pharmacy Degree have completed the initial two years at COB and will complete the programme at University Technology in Jamaica obtaining a Bachelor of Science Degree in Pharmacy from the College of The Bahamas/University of Technology Jamaica. When they are finished, these students will be available for deployment within the health sector at Public Health Clinics in New Providence and in the Family Islands and at PHA hospitals in New Providence and Grand Bahama.
In the last fiscal period, pharmacy legislation was passed and enacted and now, for the first time, there is a Pharmacy Council in The Bahamas which regulates and controls the standard of the practice of pharmacies in The Bahamas in keeping with current global trends.
A new Medical Act drafted by the Office of the Attorney General has been reviewed by the Medical Council, the Medical Association of The Bahamas, the Doctors’ Union both in the Public Hospitals Authority and the Department of Public Health. A new Medical Act will soon be on the books.
THE PUBLIC HOSPITALS AUTHORITY
I now move to address that part of my portfolio covering the Public Hospitals Authority.
The Board and Management of the PHA are to be commended for continuing to strive for greater fiscal prudence, stewardship accountability and performance excellence. During the last fiscal period, for the first time since its creation, the Public Hospitals Authority did not have to ask for contingency funding and indeed, Mr. Speaker, the Authority saw a 15% reduction in expenditure on overtime. Expenditure reductions were also achieved in other high cost areas such as electricity, gasoline and overseas patient referrals and contracts for medical services. These reductions were as a result of special cost saving initiatives implemented by management last year in the face of the severe economic situation in The Bahamas and worldwide. This fiscal prudence must become the hallmark of the PHA in the upcoming budget period and beyond.
In accordance with the PHA Act, the Authority has brought its Annual Audited Financial Statements current. The reports will be tabled in Parliament in short order.
For the upcoming 2010/2011 fiscal year, the Public Hospitals Authority was allocated a recurrent budget of $179,438,738. This represents 80% of the national health budget and 12% of the total national budget. A further $3,586,775 will be provided for capital development projects at the three hospitals and the corporate headquarters agencies of the PHA.
We have done a number of infrastructural changes throughout the Public Hospitals Authority, that is the Rand Memorial Hospital, The Princess Margaret Hospital and Sandilands Rehabilitation Centre, however, the public is not overly concerned about these changes, they are concerned with the waiting time in the Emergency room at PMH and the time it takes for admittance to a bed from the Emergency Room.
It is a known fact, that PMH is today thirty-eight (38) beds short for our population and run an average occupancy rate of eight-one percent (81%), while the Rand Memorial Hospital at fifty-five percent (55%) and Doctors Hospital at fifty-one percent (51%).
When we analyzed the delay within our institutions, we recognize that one of the primary causes relate to the timeliness in obtaining lab results, this has been improved at the Rand with the introduction of our online lab information system. This online lab information system commenced 27th April 2010, this same system will be activated at PMH and the South Beach clinic by September 2010 then further rollout to the remainder of our community clinics. We expect completion by the end of fiscal period 2011. To support the implementation of this new system at PMH, five (5) Phlebotomists were recruited to augment the laboratory staff and facilitate the timely collection of inpatient specimens at the ward level.
Another cause of delay can be attributed to our current process of individual review of emergency patients by the ward Specialist to obtain ward admission. Improvement in this process will soon be achieved by direct admission to the ward by our Emergency Room Consultants bypassing an unnecessary step in the existing process.
Finally Mr. Speaker,
The PMH Emergency Room’s square footage will be extended to include the General Practice Clinic (GPC) while this clinic will be relocated to an independent yet close location to the existing site. This change had been lobbied in excess of seven (7) years, however, a catastrophic event occurred three (3) weeks ago forcing this change and for the first time allowing the staff first- hand experience in a new and more efficient service.
The experience with this brief change, allowed us to see the value of our A&E Consultant staff triaging our patients thus again improving efficiency and decreasing the demand for unwarranted investigations. (In keeping with cost containment – in these recessionary times).
While visiting Baptist Hospital, in Florida, several months ago, I was amazed to see that they too experience delay within their Emergency Room in addition to patients being kept on trolleys. However, there was an excellent communication network between patient, staff and relatives, therefore decreasing the frustration that we see here today. The PMH and the Rand must, and will improve their communication network.
Also at Rand, a $1.75 million dollar contract for the renovation and expansion of the Accident & Emergency Department has been executed. This project has a preliminary phase requiring the relocation of the Outpatient Specialty Clinic to a leased facility on Coral Road, Freeport and the subsequent temporary relocation of the A&E Department to the Specialty Clinic space, which is situated on the East Atlantic side of the hospital. These preliminary relocation steps, with the necessary modifications to associated spaces, are scheduled to be completed in time for the main renovation works on the A&E Department to commence in June 2010, with a projected completion date of March 2011.
We still hear many cries concerning cancelled surgeries from many people within our community. Though our surgical waiting time is much lower than many first world countries, this is still another opportunity for improvement. Some surgical procedures are delayed due to the unavailability of post surgery ICU beds, while others are delayed due to the indirect correlation between the number of surgical theatres and the number of surgical specialists. Both will be addressed, as firstly our existing number (9) of ICU beds will be complimented by our soon to be introduced step down unit. Secondly, our theatres will be increased by the construction of three (3) new operating theatres as plans are currently ongoing with an expected construction commencement in September 2010.
The construction of these new theatres would allow for additional out-patient surgery, and a direct correlation to our bed admission decreasing the average length of hospital stay. (PMH = 7.8 days, Doctors Hospital = 3.5 days, and the Rand = 3.1 days).
By decreasing the average length of stay at PMH alone, by 1.5 days, we will save on average $14 million per year and decrease our bed occupancy from 81% to 66%.
Our infrastructural improvement efforts are not limited to PMH only, one (1) additional operating theatre will be constructed at the Rand Memorial Hospital. This work is scheduled to begin this month with a projected completion date of May 2011. The tenders for this work have been received, analyzed and finalized by the selection of a Grand Bahama contractor.
Infrastructural changes are not limited to PMH and the Rand Memorial, The Geriatrics Hospital redevelopment began in February 2009 (with a preliminary project for upgrading the electrical supply to this area of the campus) and is on schedule, with a projected completion date of October 2010. The renovated / expanded facility, at a total cost of $1,508,637, will greatly enhance the overall environment of care for our geriatric patients, improving family and provider satisfaction and direct patient-care.
The project of the National Insurance Board for the construction of the new inpatient facility at SRC for children with special mental health, behavioral and developmental needs is now proceeding satisfactorily and is scheduled for completion in April 2011.
Dr Margaret Chan, Director-General of the World Health Organization reminded us at the 63rd WHA Assembly last month that Public Health must never cease to learn from its successes, and its failures. We will bring all of those lessons to bear on the management of all of the resources available to us in the upcoming fiscal period. I leave you with the mission statement of the Ministry of Health - to ensure that the highest quality of services for health promotion, protection and care are accessible to all persons of the Bahamas in order to achieve optimal health.
I respectfully close with a message to the Killarney Constituency.