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NHI: What should we expect in 2016

NHI: What should we expect in 2016

Mon, Nov 30th 2015, 11:57 PM

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

Diabetic foot ulcers occur in approximately 15 percent of patients

Diabetic foot ulcers occur in approximately 15 percent of patients

Mon, Nov 30th 2015, 10:25 PM

Ulcers are slow-healing wounds on the skin. Diabetic foot ulcers occur on the feet of people with type 1 and type 2 diabetes. Diabetic foot ulcers usually occur in approximately 15 percent of patients with diabetes, and are commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.

Anyone who has diabetes can develop a foot ulcer. Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma. The longer one has had diabetes, the higher the chances of getting an ulcer. High blood sugar can damage the nerves of the legs and feet. This may make it difficult to feel a blister or sore on the foot. If you don't take care of a sore it may become larger and infected. Diabetes can also cause problems with blood flow. Poor blood flow can make it difficult to heal an ulcer. The ulcer itself is usually caused by:

o Repetitive trauma or pressure on the foot;

o Puncture wound on the foot;

o Shoes or objects in the shoe that can damage the skin, such as a small rock.

Risk factors
Factors that may increase your chance of diabetic foot ulcers include:

o Neuropathy -- numbness, tingling, or burning sensation in your feet;

o Peripheral artery disease (PAD) -- poor circulation in your legs;

o Improperly fitted shoes;

o A foot deformity;

o Diabetes for more than 10 years;

o Poor diabetes control;

o Not wearing shoes;

o A history of smoking;

Symptoms may include:

o Sores, ulcers, or blisters on the foot or lower leg;

o Pain;

o Difficulty walking;

o Discoloration in feet (skin that is black, blue or red)

o Fever, skin redness, swelling, or other signs of infection;

On your visit to the podiatrist, you will be asked about your symptoms and medical history. A physical exam will be done. Blood tests and other test, such as a wound culture, test of your circulation and x-rays may also be done.

The sooner a diabetic foot ulcer is treated, the better the outcome. Treatment options include the following:

Wound care: Good wound care is important to help the ulcer heal and prevent infection. Persons with diabetic foot ulcers should see the podiatrist as soon as possible. Wounds heal better when they are covered and should not be left open. Follow your doctor's instructions for wound care to keep the wound clean and change the dressing as the doctor orders to prevent infection.

No weight bearing: Constant pressure on the ulcer can make it worse and difficult to heal. Your podiatrist will give you a special shoe or cast boot to take the pressure off the ulcer area. This will allow the ulcer to heal.

Blood sugar control: High blood sugar levels can lower the body's ability to fight infections and keep the wound from healing. Infected ulcers can also raise blood sugar levels. Improved blood sugar control will help you fight infections and heal your wounds. This control is often done with adjustments in your diet, exercise or medications. Sometimes insulin shots are needed in the short-term to get you sugar under control.

Healthy habits: If you smoke, talk to your doctor about ways to quit. Smoking can also slow healing. Look at your feet every day, wear proper footwear and make sure it fits well.
Skin graft: Some large skin ulcers may have a hard time healing even with good treatment. They may need a patch of skin to help close the wound.  Bioengineered skin graft or human skin graft may be used.

Medication: If the ulcer is infected, your doctor may order antibiotics to treat it. You may need to take the medication for four to six weeks. Do not skip doses. Finish the medication as directed. Your doctor may also recommend a medication to place on the ulcer. The medication may help speed healing.

Surgery: Dead tissue can build up inside and around the wound. This tissue will slow or prevent healing. You may need a surgery to remove the dead tissue and clean the wound. This surgery is called debridement. Bypass surgery may be needed to improve blood flow to the legs. The improved blood flow may help with wound healing, if the infection is too severe or does not respond to treatment. As a last resort, amputation surgery may be needed. This is the removal of a body part to stop the infection from spreading to the rest of the body.

Other treatments: Hyperbaric oxygen therapy may help with healing. This therapy is delivered in a chamber. Pure oxygen is pumped into the chamber. This helps to increase the amount of oxygen in the blood. The extra oxygen can improve healing. Another option to help speed healing is using negative pressure wound therapy. A vacuum device and dressing are used to create negative pressure on the wound. This can help the wound heal faster.

To help reduce your chance of diabetic foot ulcers:

o Clean your feet daily. Dry them thoroughly, especially between the toes, before putting shoes and socks on.

o Do not wear garters and tight stockings around the legs.

o You may want to use petroleum jelly or an unscented lotion to moisturize dry, leathery feet. Do not put lotion between the toes. The extra moisture may attract bacteria.

o Inspec t your feet daily. Look for sores that you may not be able to feel. Use a mirror or the assistance of another person to see all parts of your feet.

o Your doctor should look at your feet and test the feeling in them at least once a year. If you find a sore at any time, make an appointment to see your doctor right away.

o People with diabetes may have toenails that are brittle and difficult to cut. You may also want to have a foot specialist trim your toenails regularly.

o Buy properly fitted shoes. Some insurance companies will pay for custom-made shoes with inserts. A doctor can give you a prescription for the shoes.

o Avoid smoking.

o Talk to your doctor about exercise. Daily exercise will help to improve blood flow and blood sugar levels.

o Calluses can increase the pressure on the foot and lead to foot ulcers. Have your foot doctor remove any calluses. This could reduce the risk of developing a foot ulcer.

o Ask your doctor if you should use a special infrared thermometer. It can check the temperature of your feet. Increasing foot temperatures may indicate something is going on in the foot.

o Improved control of your diabetes may reduce the risk of ulcers and help them to heal if you get one.

o For more information email or visit To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport Grand Bahama, telephone 373-7400.

Sands bows out gracefully

Sands bows out gracefully

Mon, Nov 30th 2015, 10:17 PM

Despite the fact that he and his team suffered a resounding beating at the Bahamas Association of Athletic Associations (BAAA) election of officers over the weekend, former BAAA President Mike Sands said he's not bitter about the loss and hopes the sport continues to expand here in The Bahamas.

"It's very simple, the members have spoken and we have to accept their position and just move forward," he said. "Whatever we achieved or thought we achieved was not sufficient and satisfactory to the membership and so they decided that they wanted a different course of action."

Sands served as president for the past two years, and three times overall non-consecutively. His "One BAAA" campaign was centered on some key objectives which included, establishing a merit based incentives program; creating an electronic communications system for coaches, athletes and administrators and growing the BAAA's commercial brand through long-term partnerships with corporate Bahamas.

Sands said while he would not speak to what he would like to see done under this new administration, he does hopes the sport will continue to develop, regardless of how it happens.

"It's a new day and they'll do whatever they feel is necessary to help improve the sport, and also what they promised the voters, which were the coaches and the stakeholders, which to the members was more attractive than what we did," said Sands. "We were in office to serve the people and despite how I feel we performed during our time, it's about the members' votes, and if they felt that what we did wasn't sufficient enough for another term, there's not much to debate."

The "One BAAA" team included Curt Hollingsworth, Norris Bain, Drumeco Archer, Stephanie Rahming-Taylor, Phillippa Arnett-Willie, Laketha Charlton, Bianca Sawyer, Anya Dorsett, Wayne Smith and Frank "Pancho" Rahming. Bain, Archer and Rahming were the only members elected to serve in the respective positions.

The 'One BAAA's' mission statement was: "Building a stronger federation through strengthening relationships with all athletes, coaches, technical officials, clubs and affiliates throughout The Bahamas, to ensure that we produce the best athletes through the collective support of our local communities and corporate partners, and to develop the economic and commercial brand of the federation."

Banks' credit quality worsens, property sales slump

Banks' credit quality worsens, property sales slump

Mon, Nov 30th 2015, 09:58 PM

After a period of relatively positive - if mildly so - news, The Central Bank of The Bahamas (CBOB) has reported a worsening of banks' credit quality reflective of "a deterioration in a few institutions' loan portfolios". And the bank reported a steep decline in tax receipts from real estate transactions, as property sales slumped.

Loan delinquencies rising
Total private sector loan arrears rose by just under one percent to $1.193 billion, accounting for 19.8 percent of total loans. In terms of the components, non-performing loans (NPLs) expanded by 0.8 percent to $900.5 million, and the attendant loan ratio rose to 15 percent. Short-term (31-90 day) delinquencies rose by 1.4 percent to $292.6 million, to account to 4.9 percent of total loans.

According to the CBOB Monthly Economic and Financial Developments report for October 2015, a disaggregation by loan type showed that the rise in total arrears was largely attributed to the commercial component, which increased by 6.3 percent to $219.7 million.

Consumer loan delinquencies rose slightly by 0.3 percent to $311.6 million, as arrears in excess of 90 days advanced by $11.3 million (5.4 percent), to offset the $10.3 million (10.1 percent) decrease in 31 to 90-day delinquencies. In contrast, the mortgage segment contracted by $3.2 million (0.5 percent) to $661.8 million, owing to declines in both the non-performing and short-term components, of $2.1 million (0.4 percent) and $1.1 million (0.7 percent), respectively.

"Given the rise in delinquencies, banks increased their total provisions for loan losses by $7.4 million (1.4 percent) to $531.1 million. As a result, the ratio of provisions to arrears firmed by 21 basis points to 44.5 percent, while the corresponding non-performing loan ratio grew by 37 basis points to 59 percent. During the review period, banks also wrote-off an estimated $14.0 million in bad debts and recovered approximately $1.7 million," the bank wrote.

Interest rates
The bank also reported that the weighted average deposit rate at banks declined by 37 basis points to 0.93 percent, with the highest rate of five percent offered on fixed balances of over 12 months. In contrast, the weighted average loan rate firmed by 11 basis points to 12.09 percent.

The bank reported that the government's overall deficit narrowed sharply by $91.6 million - just over 60 percent - to $60.3 million during the first three months of FY2015/16, supported by a tax-led 38.1 percent rise in total revenue, to $437.1 million, which outpaced an increase in aggregate expenditure, to $497.4 million.

"In particular, buoyed by a net intake of $165.5 million in VAT, tax receipts surged by $113.7 million (40.8 percent) to $392.2 million. In a modest offset, taxes on international trade contracted by $15.8 million (11 percent) to $127.4 million, reflecting respective declines in import and excise taxes, of $10.1 million (13.3 percent) and $8 million (12 percent), which overshadowed a slight $2.3 million increase in export tax receipts.

"With the elimination of the hotel occupancy tax in January 2015, following the introduction of the VAT, selective taxes on services were almost negligible, at $0.1 million, compared to $12 million a year earlier. Nontrade stamp taxes declined by $10.5 million (30.3 percent), attributed mainly to a sharp $17.8 million (68.3 percent) falloff in tax receipts from real estate transactions, as property sales slumped, while timing-related factors led to a $10.1 million (63.4 percent) contraction in business and professional fees, to $5.8 million.

"In contrast, nontax revenue rose by $10.3 million (29.5 percent) to $45.2 million, as the payment of dividends by a major telecommunications provider contributed to a more than four-fold increase in income to $13.9 million," the bank reported.