Mr. Speaker, I wish to begin by thanking the Almighty God for the wonderful privilege and opportunity to represent the Great People of North Andros and the Berry Islands in this Honourable House. As the Minister of Health with responsibility for the Department of Public Health inclusive of the Community Clinics throughout The Bahamas and the Public Hospitals Authority inclusive of the Prince Margaret Hospital, the Sandilands Rehabilitation Centre; the Grand Bahama Health Services National Emergency Medical Services; Bahamas National Drug Agency and the Materials Management Directorate, I hereby rise Mr. Speaker to provide an account of the on-going developments, and successes which we have achieved in the first half of the 2015/2016 fiscal year.
However, Mr. Speaker, I would be remiss if I did not take a minute or two to comment on the fiscal situation we inherited upon assuming Office in May 2012. Mr. Speaker, as you would recall, this government led by the Rt. Hon. Perry Gladstone Christie inherited a fiscal situation where there was a little over $4 million in the Budget and to exacerbate the situation the public wage bill stood at $50 million which meant we started with a deficit of $46 million alone with respect to payment of salary for our public servants.
Unfortunately, this fact, Mr. Speaker, is often lost when we talk about the very poor state that the side opposite left the Public Treasury in and surely no caring government could ever be proud of leaving the state of our public finances in such a poor state.
Mr. Speaker, I wish to commend the Prime Minister and Minister of Finance for the commendable job that he is doing in restoring discipline to the management of public finance. As you are aware, Mr. Speaker, the government’s Medium-Term Fiscal Plan comprises the following: (i) restraining the growth of public expenditure; (ii) modernizing and enhancing revenue administration; (iii) securing new resources of revenue; and (iv) growing the economy.
Mr. Speaker, I am pleased to state that the Prime Minister and Minister of Finance is on the right track evidenced by his declaration during the Mid-term Budget Review on Wednesday last, in this House, that the government has succeeded in reducing the fiscal deficit from $539 million three (3) years ago to the projected $141 million this year representing a deficit reduction of $398 million or 75 percent. Mr. Speaker, this is a sentinel moment marking an incredible feat in three (3) years under the government’s Medium-Term Fiscal Consolidation Plan.
I make this point, Mr. Speaker, because it clearly demonstrates that the government led by the Prime Minister and Minister of Finance is headed in the right direction in containing public expenditure thereby reducing the growth in both the Recurrent Account and GFS deficits. Thus, I commend the Prime Minister and Minister of Finance for the improved management of our public finance and have every confident that he would continue to stay the course.
CLICO Bahamas Liquidation
Mr. Speaker, I wish to commend the government for having agreed the CLICO Bahamas Liquidation Plan proposed by the Liquidator of CLICO to make all existing policyholders whole through the creation of a special purpose vehicle under which surrendered policies; death benefits; medical claims; and pension policies will be paid in full. Further Executive Flexible Premium Annuities holders and surrendered pension policies will be settled in cash to a maximum of $10,000.00 per person and the balance will be supported by 7 – year promissory notes with interest at Prime payable quarterly. Mr. Speaker, the total cash payouts under this plan is estimated at $16million and as such, I join the Prime Minister and Minister of Financing in stating that this is yet another demonstration of a caring and compassionate government.
The Ministry of Health
Mr. Speaker, I now turn to the activities of the Ministry of Health. It gives me great pleasure to address this Honorable House at this time during the mid-year budget exercise. The Bahamas has been awaken by the clarion call from the team of healthcare providers who are in preparedness mode to readying the nation for a much healthier Bahamas by 2030. Therefore it is with pleasure that I am presenting the many initiatives we have been able to initiate in the first half of the budget year 2015 – 2016.
Mr. Speaker, as we progress further with this communication it would become increasingly clear that the Ministry of Health is well on the way to putting the government mandate for implementation of NHI in place, this year, throughout our country from Abaco in the North to Inagua in the South. All of the relevant stakeholders are being engaged at every step in the process and the differences which previously divided them, because of differing of opinions, are now far less with the gaps closing considerably. What is very clear, Mr. Speaker, is that all concerned people agree with the concept of Universal Healthcare Coverage (UHC). The understanding of the value of National Health Insurance (NHI) as the funding mechanism for the healthcare initiative is becoming better understood amongst the citizenry and residents in the Bahamas.
Mr. Speaker, the majority of the population has expressed feedback that supports the introduction of NHI. However the input is in support of a gradual process being implemented giving optimal consideration to the best utilization of all of the resources available. Thus, the Ministry of Health System Strengthening team has been inclusive to ensure the quality of the processes and infrastructural upgrades that are being introduced are sound and culturally suited for the delivery of healthcare in our archipelagic environment. This is necessary to satisfy the health needs of the nation with particular emphasis on the most vulnerable groups such as the children, elderly and the poor.
Mr. Speaker, in the new model of healthcare moving forward the emphasis will be on staying healthy: Prevention, Promotion, Protection and Ambulatory Care. The aim being to keep communities healthy and when people become unwell to limited the institutional in-hospital care to as short a period that this appropriate in keeping with the recommended therapy regime. In order to achieve these goals which are recommended and endorsed by the WHO/ PAHO “Health in All Policies” Resolution the Ministry of Health has strengthen the relationships in policy development with the Ministry of Education, Science and Technology; the Ministry of Agriculture and Marine Resources; the Ministry of Social Services and Community Development; the Ministry of National Security; The College of the Bahamas; Ministry of Youth, Sports and Culture; the Ministry of Works and Urban Development; the Ministry of Environment and Housing; the Ministry of Tourism; the Ministry of Transport and Abiation; the Ministry of Finance; the Bureau of Standards, Ministry of Financial Services and Local Government; and made a substantial contribution to creation of the National Development Plan.
The Ministry of Health partnering in this manner with its sister Ministries and other Non-Government Organizations (NGO’s), such as religious organizations, will play a significant role going forward in the transformation of The Bahamas to the Vision of the peoples residing in The Bahamas to being classified as ranking amongst the top ten healthy nations globally by the year 2030.
Mr. Speaker, in order to set the stage for the implementation of National Health Insurance in the coming months we shall be “rolling out” what is referred to as the Ministry of Health Health Systems Strengthening “Quick Wins” in the weeks and months ahead; indeed the process is already a reality in some of the areas:-
· Nationwide Community Town Hall Meetings to receive feedback from the communities to tweak the delivery of the upgraded health services started with the draft legislation
· Training of a new cadre of allied healthcare workers in several different categories e.g. Patient Care Technicians, Operating Surgical Technicians, Emergency Medical Technicians, Anesthesia Assistant Technicians and Cross Training of the technicians to improve efficiencies and effectiveness of services. A series of graduation ceremonies are now being scheduled to begin in the next two months. Once the graduations are completed the allied healthcare workers would be available to be strategically deployed in particular aspects of the healthcare system to fill the gaps for the change to an Ambulatory Community Driven Model of Care with the focus on prevention and wellness
· The decongestion of the Accident and Emergency sections at both the PMH and the Rand would have relief with movement of suitably selection of patients being removed into residential homes for care
· The Ministry of Health will establish a Bahamian version of N.I.C.E. (National Institute for Clinical Excellence) with the formation of a partnership with the United Kingdom National Health Service. This is expected to further upgrade the overall quality of healthcare being delivered in the country.
Mr. Speaker, at the end of April, 2016 the Bahamas Healthy Lifestyle Coalition will be launch which is a preliminary feature in the introduction of the NHI program because it is a significant National inclusive exercise. This will benefit all sectors of the society in a well-organized national program that will provide indicators for measurements of national, regional and global benchmarking to be able to create evidence based policies to address the trends with the results obtained throughout the life years of the NHI Initiative.
In keeping with the Universal Healthcare principles, Mr. Speaker, the Ministry of Health will remove the need to pay for services at the point of care which will create easier access to all healthcare services; without the financial barrier to care. This will include a mechanism to address cost for emergency air transport services which can be a considerable burden to residents in the Family Islands
Mr. Speaker, today, my Ministry and the Public Hospitals Authority will execute a Memorandum of Understanding between the University of Miami Leonard M. Miller School of Medicine and the University of Miami Leonard M. Miller Schoool of Medicine Interdisciplinary Stem Cell Institute (MOU); and my Ministry also executed a Consultancy Services Agreement with Dr. Joshua M. Hare, M.D., Consultant (CSA) which are designed to strengthen and improve the overall capacity of the Ministry of Health to delivery advance medical services in the area of Stem Cells and other highly specialized tertiary care services. This MOU and CSA will “Frog Leap” The Bahamas into a higher plane in the global health arena with significant potential for the local healthcare industry to introduce more sophisticated services in country; and to enhance research and therapy in the emerging Stem Cell Industry.
Mr. Speaker, to maintain balance as we increase the capacities in the healthcare infrastructure with the human resources, the Ministry of Health is re-engineering the Monitoring and Evaluation capabilities of the Ministry at this transformational juncture in our history. To this end and with the support of PAHO, we have retained the services of one of the top epidemiologist and researcher in the Caribbean Region namely Dr. Donald Simeon, who have already joined the team at the Ministry of Health for the next six months to enhance the preparedness phase.
The whole area of Research and Development which we have talked about previously for years with respect to the potential of the many additional benefits that can accrue has now been addressed. As healthcare providers we could make better use of the vast amount of good information material available in The Bahamas; with “professional packaging” to bring it to the World Stage. The process to achieve this goal is a reality and we look forward to the alignment of the healthcare indicators nationally, regionally and globally in a manner that will make The Bahamas a model for the Developing World.
HIV/AIDS
Mr. Speaker, The Bahamas has seen major declines in new HIV infections and AIDS-related deaths since the start of the epidemic in 1983. This success demonstrates the commitment of the Government directed at the epidemic. In 2014, 279 persons were diagnosed with HIV infection in The Bahamas, a decrease of 25% between 2004 and 2014. Fewer people are dying of AIDS-related causes – the age adjusted death rate has decreased from 38 to 22 deaths per 100,000 in this time period. The work and success of the Ministry has been large part due to the strong partnership with the National HIV/AIDS Programme and other community groups and leaders.
The Bahamas is known for its strong Prevention of Mother to Child Transmission of HIV Programme and was a regional best practice. Further, we have an active and successful programme over the past decades to control and eventually eliminate the mother to child transmission of HIV and syphilis. Since 2001, antiretroviral treatment for HIV positive pregnant women has been introduced to our antenatal and delivery services. With this positive approach, the rate of perinatal transmission of HIV has decreased over the period to elimination levels. In addition, we have not recorded a single case of congenital syphilis in the past five years.
Mr. Speaker, my Ministry has recently sent a request to PAHO to be included in a validation exercise of the local EMTCT programme. The validation team is expected to be in country during mid to late 2016. In order to prepare for the aforementioned validation exercise, my Ministry has established a committee to coordinate all activities necessary in the pre-validation process.
It is, therefore, evident that the National AIDS Programme continues to successfully coordinate the country’s response to HIV/AIDS, despite the National HIV/AIDS Centre operating at a 75% staff complement.
Most notably, Mr. Speaker, during the first part of the 2015/2016 fiscal year, my Ministry has drafted of a new Strategic Plan 2016-2020, which is aligned with the World Health Organization, Global Health Sector Strategy on HIV 2016-20121, Universal Coverage and the UNAIDS Strategy 2016-2021. It is also aligned with additional regional health strategies, including the Pan American Health Organization Regional HIV/STI Plan for the Health Sector. I am proud to report that this draft plan is now in the final consultation phase with various civic society and other stakeholders, and should be signed off by my Ministry by the end of this fiscal year.
Mr. Speaker, I must make my colleagues aware that this work is being done under the able leadership of the Director for the National AIDS Programme, Dr. Nikkiah Forbes, who at the end of 2015, was qualified as an Infectious Diseases Physician – only the second one, besides myself, in country. This builds the capacity of the National Programme to deal with changes in the HIV/AIDS epidemic, as well as anticipate and adapt to new technologies regarding prevention, testing, treatment, care and support.
The Bahamas stands in unity with the UNAIDS Global Action Plan of embarking on Fast-Track Strategy to end the epidemic by 2030. My Ministry is committed to achieving this goal, and is taking steps to scale up activities and making sure that no one is left behind. We are in the process of strengthening systems, upgrading facilities and dedicating additional resources to this effort.
A partnership between the NAP and ICF, a PEPFAR recommended partner, has been extremely successful with a curriculum being completed that has sixteen (16) modules, dealing with Provider-Initiated Testing Counselling (PITC), stigma and discrimination, key populations and rapid testing, among others. This curriculum is now used for the training of healthcare workers in both the public and the private systems.
During the fiscal year Ministry conducted training sessions in Level 1 of the Caribbean Regional Field Epidemiology and Laboratory Training Programme (CR-FELTP) which included lectures on basic bio-statistical measures, principles of information representation and distribution, principles of surveillance and outbreak investigations, and the use of Microsoft Excel, Microsoft Word and the Internet in public health activities.
Mr. Speaker, the Reference Laboratory successfully completed a re-accreditation exercise by the esteemed College of American Pathologists, in September 2015, and remains the second lab of its type in the Caribbean. The Lab commenced a HIV Drug Resistance and the associated HIV Genetic Research Programme. Preparation is underway to commence other diagnostic and prognostic tests (outside of HIV), including for Zika, Chikungunya, Dengue, and breast cancer tumour markers (that is, the BRCA gene identification). Ground work has been laid to participate in the Caribbean Public Health Lab Network (CarPHLN).
To better assist with this important work, my Ministry increased the Reference Lab staff complement by four (4) persons (a driver for specimen transportation, receptionist, technologist and phlebotomist) supervised by Reference Lab Manager, Dr. Indira Martin. This lab continues to act as an External Quality Assurance (EQA) site for HIV diagnosis, through the provision of Dried Tube Specimen-EQA and DNA-PCR used for early infant diagnosis. Further, the lab plays a major role in the ongoing decentralization process. The Reference Lab has also extended HIV lab services (including the logistics of blood transport and data management) to several new decentralized sites in the Family Islands.
Department of Public Health
Mr. Speaker, I turn to the Department of Public Health. The decision of the Government and my Ministry to pay focused attention to the reform of the health care system and in particular to the strengthening of the primary Health Care System is due to several key factors:
(1) Primary Health Care Services has been and will continue to be the best and the most cost effective and equitable strategy for improving the population’s health especially in a community such as ours and to implement the Universal Health Coverage.
(2) Our statistics for the past five (5) years has shown that 80-85% of all visits to public health institutions are made at the primary health care level with over 400,000 visits being made at health facilities in New Providence, Grand Bahama and in the Family Islands in 2014.
(3) Primary health care is also the most effective strategy for the engagement of citizens in the participation of the development, planning, implementation and evaluation of services which best meets their needs and has shown to yield the best outcomes through this collaborative effort.
To begin this process of improving the delivery of health care services at the community level, my Ministry through the Department of Public Health, has embarked on several strategies to advance Universal Health Coverage, these includes the improvement of access to non-urgent and urgent health care services in New Providence and the Family Islands. Toward this end, we have recommended the extended hours of service at the Elizabeth Estates Clinic.
Mr. Speaker, for the first time since the construction of the Fleming Street Clinic in 1989, this clinic is providing extended hours of services from 9:00 a.m. – to 9:00 p.m. which means that all the four (4) poly clinics are providing services between the hours of 9:00 a.m. – to 9:00 p.m., Monday to Friday. Secondly, we have recruited and employed additional Pharmacist and Pharmacy Technicians to ensure that persons attending these facilities are able to access medication after being seen by their Doctors. Mr. Speaker, so far the recruitment of these persons, have resulted in clients being able to receive their medication during their visit to the clinics and or data has shown a 15% increase in the number of prescriptions being filled at the Fleming Street Clinic between the hours of 5:00 p.m. and 9:00 p.m.
Thirdly Mr. Speaker, we have recruited and deployed additional physicians to clinics in New Providence and the process is continuing to provide an effective appointment base system to reduce the rush to the clinics early in the mornings and to reduce the waiting time for persons seeking care. Toward this end, I have issued instructions to ensure that clients are no longer waiting outside in the elements nor are they waiting excessively for services at our facilities.
I am indeed pleased, Mr. Speaker, to announce that presently we have deployed Doctors to all of the Islands who in the last budget period were without a resident Doctor. These Islands include (i) Kemps Bay, Andros; (ii) Cat Island; (iii) Fresh Creek, Andros; Bimini; and San Salvador.
Mr. Speaker, it has been along time coming and, for the first time, we have employed a resident Doctor to the Berry Islands and will continue our recruitment of Doctors for (i) Spanish Wells; (ii) the Exuma Cays; (iii) Sandy Point and Moore’s Island, Abaco; and Crooked Island and Mayaguana…..to ensure equitable access to health care services.
In addition to the recruitment and deployment of Doctors and Nurses, Mr. Speaker, I am pleased to state that, for the first time, we have embarked on one of the more aggressive recruitment of health care workers in the Allied Health Profession to improve and sustain access to diagnostic services during routine and extended hours. These categories include (i) Pharmacists and Pharmacist Technicians; (ii) Laboratory Technologists and Technicians; (iii) Radiographers and Technicians; (iv) Ultra-Sonographers; (iv) ECG Technicians; (v) Physiotherapists; (vi) Nutritionists; and (vii) Health Educators.
These individuals will not only be deployed in New Providence but to the Family Islands as well to ensure that we provide equitable opportunity for self-improvement and the right to information and services to maintain health and quick recovery from illness.
By April 2016, Mr. Speaker, there will be sustained access to Laboratory and X-Ray services at the South Beach Health Centre between the hours of 9:00 a.m. to 9:00 p.m., so clients visiting any of the public health clinics can receive urgent laboratory testing and x-ray taking, instead of going to the hospital. This, Mr. Speaker, will reduce unnecessary burden on the Accident and Emergency Department of Princess Margaret Hospital.
Mr. Speaker, my Ministry is cognizant of the need, to improve the experience that clients receive when they visit our institutions. In addition to ensuring that clients will no longer wait outside in the elements, my Ministry, has begun a Customer Service Training for all categories of staff to ensure that there is complete understanding that the patient or the clients and their families must be the centre of the care we provide for them. Toward this end, we have already commenced training of health care workers in New Providence and the Family Island to strengthen the capacity of providers to teach clients and their families in regards to strategies to improve and maintain their health.
Mr. Speaker, I am pleased to inform you that by April 2016, the New Community Primary Health and Specialists Health Care Centre in Exuma will begin offering services and by June 2016, the New Facility in Abaco will begin delivery of services at their new site. The construction of these two Modern Advanced Primary Health Care and Specialists Centres are not only in response to the needs of the population for whom they will serve, but these facilities are said to be the Jewel of the Caribbean, as the infrastructural capacities allows the health system to provide Out-Patient Specialists Services normally provided in hospital at the community level and as a result, there should be a 50-60% decline in the number of clients being referred to the PMH and RAND hospitals due to the availability of Diagnostic Services, Telemedicine Services and Visiting Specialists Services. The operation and delivery of services at these two modern health centres will also facilitate access to services for persons in the Cays and adjacent Islands, creating a Local Health System Network.
Further, Mr. Speaker, one of the Special features at these facilities, is the ability of doctors to admit persons for short periods of less than 48 hours for non-urgent care, due in part to the availability of diagnostic services and “real time” specialists services via telemedicine technology.
Infrastructure Development
Mr. Speaker, there are some 100 Primary Health Care Centres providing various levels of care throughout The Bahamas. Unfortunately, the maintenance and upkeep and the expansion of these facilities to meet the population needs or to provide for access to e-health and Specialists services has been lagging. Toward this end, we have engaged the services of four (4) private Architects in addition to the team from the Ministry of Works to assess these facilities, develop Architectural drawings and scopes of works to affect the necessary repairs or expansion as well as the construction of new facilities. It is anticipated that over the next three years these projects will be completed.
However, Mr. Speaker, I am pleased to inform that for the Island of New Providence the following has occurred:
Ø A new clinic has been formally provided for the residence of the Adelaide District on a daily basis.
Ø Architectural Plans to provide for the redesign of the Elizabeth Estates and Flamingo Gardens Clinics by Mr. Alvan Rolle of Alvan Rolle and Associates are near completion and will be submitted shortly to the Ministry of Health and Works for the necessary approvals.
Ø Planning for the South Beach Health Centre will be more detailed, as this facility will also provide for an Advanced Out-Patient Specialist centre; an Infectious Disease Wing; a centralized storage capacity for pharmaceutical and other supplies to reduce supply outage; and a biomedical worksite to affect immediate repairs and timely return of equipment to health care facilities in New Providence and the Family Islands. The expansion will also result in a layer laboratory and other diagnostic services.
Ø Repairs for the Fox Hill Clinic have been completed and services has recommenced. It is anticipated that the official re-opening will occur by May 2016.
Ø Plans to provide for the redesign, and repairs of the Ann’s Town Clinic is near completion and should be submitted to the Ministry of Works for approval within another week.
Mr. Speaker, I now wish to inform of the tremendous amount of infrastructural work being carried out in the Family Islands. As you are aware, a number of facilities were damaged by hurricane Joaquin. Presently contracts have been signed for the repairs to the Government Clinics in Acklins and Crooked Island. Contracts are being revised to affect repairs at Government Clinics in Roses and Deadman’s Cay, Long Island and the scope of work to affect repairs and correct design flaws to the roof at the Cockburn Town Clinic in San Salvador will be completed next week.
Acklins & Crooked Island
Notwithstanding these repairs, Mr. Speaker, the Architects have visited these Islands impacted and architectural design to facilitate the conversion of the existing Doctor’s residence in Spring Point, Acklins to a clinic is near completion. This building is larger and able to provide for expansion of services and an overnight room. The construction time is 6 months. In the meantime, the Government residence in Delectable Bay will be renovated to provide accommodation for the Doctor, followed later by conversion of the old clinic to a residence.
Mr. Speaker, plans are also underway to convert the existing Government Clinic in Salina Point, Acklins to a Nurse’s residence to provide for a resident Registered Nurse to this population of over 200 residence who live some 40 miles away from the main facility in Spring Point. I wish to take this opportunity to thank Dr. Koli Roa, the former District Medical Officer for Acklins, Mrs. Ethlyn Bain, retired Trained Clinical Nurse and Mrs. Pandora Williams, the current Trained Clinical Nurse in Salina Point for the tremendous work they have done in providing care and services under these challenging conditions. The impact of these repairs and posting of officers to Salina Point by the end of the year will result in the relocation of the Salina Point Clinic closer to where the community lives. Also plans are being carried out to improve access to residence in the Lovely Bay, Mason’s Bay and Chesters communities through the posting of a full-time residence Nurse at the Chester’s Bay Clinic.
Cat Island
Mr. Speaker, I am pleased to inform that approval has been granted for the improvement of infrastructure at the Old Bight and Orange Creek Clinics in Cat Island and designs are being finalized for the renovation and upgrading of the Smith’s Bay Clinic to provide for onsite, point of care laboratory testing and x-ray taking. San Salvador & Rum Cay In addition to the repairs and redesign of the Cockburn Town Clinic, architectural design for the construction of a new clinic in United Estates, San Salvador and Rum Cay has been completed. Long Island Mr. Speaker, in addition to repairs being done to facilitate post hurricane repairs, plans are also underway to construct a new clinic for the residence of Clarence Town. Redesign and expansion will be carried out at the Deadman’s Cay Health Centre and Simms Community Clinic; and it is hoped that collaboration with local residents will result in an agreed site for the construction of a new facility in the Deep North Long Island District.
Andros
Mr. Speaker, assessment has occurred at all of the clinics and residence in the North Andros, Fresh Creek, Mangrove Cay and Kemp’s Bay Health Districts. Priority attention is being given at the Mangrove Cay Clinic at this time. However, plans are underway to expand the Nicholl’s Town Clinic to provide for onsite laboratory testing, x-ray and other diagnostic services in anticipation of the population growth. In addition, renovation, redesign and upgrade of the Fresh Creek, Kemp’s Bay and all Satellite Clinics and residences throughout Andros will begin shortly and a new clinic is proposed for the Red Bays Community.
Berry Island
Mr. Speaker, one of the strategies being used in the design and expansion of these facilities is the creation of a template clinic based on population size and health needs which can easily be adapted to facilitate easy construction of a health care facility. Therefore, a green space is being sought to facilitate the immediate construction of a new facility in the Berry Island within the next few months.
Eleuthera
Mr. Speaker, the assessment of health care facilities in North Eleuthera, in particular Spanish Wells, Harbour Island, Lower Bogue, The Bluff and Gregory Town has been completed. Scopes of work for the Spanish Wells Clinic has been completed and Harbour Island Clinic scope of work will be completed by next week. Both of these scopes will go to tender by the end of the month. Further, assessment has also started in the South Eleuthera District, with plans to construct a new facility in the Rock Sound Health District.
Exuma Cays, & Ragged Island
Mr. Speaker, I am pleased to report that the assessment of the old George Town Clinic has been completed and plans are being drawn for the conversion of the George Town Clinic into residences to provide accommodations for the deployment and new health care workers. Scopes of works are also near completion for the renovation of the old Doctor’s residence in George Town and existing residence in Forbes Hill to provide accommodations for almost 20 new health care workers.
Mr. Speaker, while the assessment has not been completed for the Exuma Cays and Ragged Island, recommendation has been made for the construction of new facilities in Black Point, Farmers and Staniel Cay and Ragged Island. As stated earlier, the template architectural plans will be adapted to facilitate the timely construction of these facilities.
Abaco
Mr. Speaker, my Ministry is in discussion with an additional Architect to affect repairs to health care clinics and residence in the Abaco District. These, Mr. Speaker, are just some of the highlights of health system strengthening initiatives which are being carried out by the Department of Public Health to strengthen the health care delivery system to provide safe-high quality and equitable health care services to our residence throughout The Bahamas.
Public Hospitals Authority
Mr. Speaker, I now wish to address matters related to the Public Hospitals Authority, inclusive of the Princess Margaret Hospital, Sandilands Rehabilitation Centre, Grand Bahama Health Services, National Emergency Medical Services and the Materials Management Directorate.
I am pleased to report, Mr. Speaker, that the PHA has been aggressively engaged in the implementation of important strategies for achieving the targets being set for health systems strengthening in preparation for NHI. These strategies are focused on strengthening our systems for clinical care; addressing fiscal stewardship and management efficiency responsibilities; improving information systems; and improving the infrastructure and physical environment of our health facilities. These strategies are progressing extremely well, as members will appreciate from my presentation.
Mr. Speaker, the PHA was allocated a total budget of just over $201.1 Million Dollars for this fiscal year 2015/2016; and for the first six months ending December 2015, a total of $115.34 Million Dollars was spent. As expected, we continue to see increases in expenditure for Drugs (at $2.9 Million Dollars), Medical Supplies (at $2.4 Million Dollars) and Dialysis Services (at $1.3 Million Dollars). These increases are the result of more patients requiring services at our public institutions.
In fact, Mr. Speaker, the government is projected to spend $17.5 million dollars on drugs for its three hospitals and 94 clinics throughout the country; and a further $13.5 million will be spent on Medical/Surgical Supplies and Medicines required for our public facilities, by the end of fiscal year 2015/2016.
Systems for Clinical Care
Mr. Speaker, with respect to our efforts for strengthening our Systems for Clinical Care, I am pleased to advise of the significant initiatives underway within the Public Hospitals Authority for the Digitization of Radiology Services.
When I became Minister of Health, Mr. Speaker, my government spoke of the challenges that we found in the Diagnostic Imaging and Radiology Services in our facilities. There was a critical need to provide upgraded and new equipment in these areas to improve the efficiency and quality of clinical care.
Mr. Speaker, I can report that in the first half of this fiscal year, the PHA completed a Radiology Services Needs Assessment to inform the development of a Strategic Plan for the replacement and upgrade of radiology & imaging equipment at the Princess Margaret and Rand Memorial Hospitals. I can further advise this Honorable House that in February 2016, a contract was executed for the procurement and installation of those items targeted for deployment in the first year of this plan, at a cost of $7.5 million. These sets of equipment that will be implemented over the remaining course of this current fiscal year are Digital X-Ray Systems, CT scanners, Ultrasound Machines and MRI Scanner. Additionally, the associated items of a Picture Archiving and Communication System (PACS) and a Radiology Information System (RIS) will also be included.
There are many benefits, Mr. Speaker, to be gained with this investment all of which leads to improved quality of clinical care to our patients and operational efficiencies. These benefits include:
• Increased access to consultation with other radiologists within The Bahamas and internationally (via tele-radiology)
• Faster and more reliable access to diagnostic images among health care providers and to archived diagnostic images and results
• Reduced wait-times and turn-around times through digital transmission rather than film and by improving throughput and workload efficiency
• Reduction of duplicate tests
This phased digitization of Radiology Services within the PHA, together with the implementation of PACS and RIS systems will allow for the early roll-out of the proposed TELERADIOLOGY PROGRAMME within the public healthcare system. This is a critical development for improving access to critical diagnostic services, especially by Family Island patients. In fact Mr. Speaker, this investment in our Radiology and Imaging Services is the single largest expenditure ever, in the long history of our public healthcare system.
Mr. Speaker, members may recall that another quality improvement initiative that was planned, linked to the commissioning of a Core Laboratory in the new Critical Care Block at the Princess Margaret Hospital, was the achievement of international accreditation of our laboratory facilities at PMH. I am pleased to note that this exercise is actively continuing with all expectation of attaining this goal through the regional accreditation body, ISO o15189. This accreditation will be another feather in our cap and will advance our health system further along the path of accreditation of all the clinical care areas of our health facilities. This is a goal that we must always strive to reach and maintain.
Management Efficiency/Fiscal Stewardship
Mr. Speaker, my Ministry and its agencies are continually assessing the services we provide, to identify opportunities to optimize the use of all our available resources. Members will note that an in-depth review and evaluation of the public sector supply system for medicines and medical/surgical supplies was completed in June 2015, which resulted in several strategies being recommended for strengthening the supply chain management systems for our hospitals and community clinics. Since then the government, through the Public Hospitals Authority, has begun the implementation of several initiatives to address some of the challenges facing the system.
The process towards the regularization of contracts with suppliers for medicines has begun in earnest supported by the full implementation of an Online Tender Management System. This system serves to greatly enhance the transparency, confidentiality and fairness of the tender process thereby evoking the confidence of our local vendors and overseas manufacturers in the integrity of the bidding process. This online system also significantly reduces the turnaround time for the decisions relating to the award of contracts. These benefits augur well for a high level of participation in the bidding process and the government’s ability to obtain competitive prices for high quality medicines, medical/surgical supplies and other health commodities.
Another critical initiative is the soon to be published National Medicines Formulary. The compilation of the Formulary has received broad based input from both general practice and specialist clinicians and pharmacists to ensure the accessibility of good quality essential medicines that are affordable and are rationally used. This marks an important contribution to the establishment of a reliable and good quality health service for the citizens of the Commonwealth of The Bahamas. I must hasten to say, that we are keeping pace with technology by ensuring that the Formulary will not only be available in printed form, but will also be accessed online by our healthcare team from a computer and even from their mobile phone.
Mr. Speaker, another initiative of the Public Hospitals Authority that I must mention, relates to the steps that are underway for streamlining our procurement and supply chain management services through the consolidation of existing agencies into a single Supplies Management Agency that will be responsible for the supply chain from end-to-end. This will serve not only to optimize the use of our resources, but provide the necessary checks and balances to improve accountability, standardize supply chain operating procedures and practices including storage and distribution, and ultimately eliminate stock-outs and wastage. We have already identified premises to house this consolidated Supplies Management Agency and started to put the restructuring apparatus in motion.
The premises for the housing of the new Supplies Management Agency will also provide space for the establishment of a centralized warehouse for vital life-saving medicines to complement the warehouse we already have in operation for our medical and surgical supplies. The establishment of this centralized warehouse is just one of a set of critical initiatives being pursued towards overcoming the challenge we face with stock-outs. Others include more effective monitoring of suppliers to ensure compliance with contractual agreements and the establishment of appropriate inventory management practices at all of our health facilities throughout the country.
Human Resources Management and Training
Mr. Speaker, let me emphasize that this government placed, among its highest priority, those strategies that seek to ensure that for our most important resource - the 4,000 odd employees of the Public Hospitals Authority – positive worker relations and effective staff development programmes are in place.
Members may be aware that on October 29, 2015 the Public Hospitals Authority has executed new Industrial Agreements with the Bahamas Nurses Union. The first is for the period 16th November 2010 until 15th November 2015; while the second cover the period 16th November, 2015 to 15th November, 2020. These have been registered with the Labour Department effective February 15, 2016 and provide many benefits for our dedicated nurses.
Mr. Speaker, I am also pleased to report that, one of the strategies being undertaken for strengthening our healthcare system, include the recruitment of additional staff to reduce critical shortages, where required. It should be noted there is a significant shortage of available Bahamian health professionals in a number of areas of need; and recruitment from abroad is often required. I therefore take this opportunity, to advise members that during the month of April 2015, a special recruitment exercise was undertaken to engage forty-one (41) healthcare professionals in areas where the entire public healthcare sector is experiencing serious deficits, including: Medicine, Pharmacy, Biomedical Equipment Engineering, Rehabilitation Therapy and Information Technology. To date, eighteen of these professionals have been recruited and it is anticipated that the balance of these much needed professionals will be in place before the end of this budget year.
Mr. Speaker, The Public Hospitals Authority (PHA) in its committed effort to assist employees in career training and professional development, affords opportunities for them to matriculate in diverse educational settings and skills upgrading. Participants enroll in training and professional development programs offered In-house and externally including university accredited programmes. Millions of dollars are spent annually for staff training and professional development; in fact, Mr. Speaker, the Public Hospitals Authority, over the past three years, spent almost $6million dollars on training alone.
A noteworthy example of our training initiatives in this regard is the programme leading to the creation of the new cadre of health workers known as Patient Care Assistants. This category of worker is expected to elevate our nursing support services at the front line of care to the benefit of our patients and health outcomes.
It is also noted that with the timely facilitation effort of the Public Hospitals Authority, five (5) family Medicine Specialists were deployed in September 2015, to the Berry Islands, Exuma, San Salvador, Bimini and Marsh Harbour, Abaco. This marks the first time in Bahamian history that physician specialists have been posted to the Family Islands. The implementation of the extended hours of the pharmacies at PMH, Rand and selected Community Clinics have commenced and others are on stream to commence during this fiscal year, with the engagement of twenty-two (22) pharmacists shortly. Mr. Speaker, this is indeed significant progress.
Health Information Management Systems (HIMS)
Mr. Speaker, I am also pleased to report that the Public Hospitals Authority is working hard to upgrade and standardize the Patient Information Systems across all public healthcare facilities. There is an important goal of achieving the “One Patient: One Record” approach to patient care. Specifically, it is our vision to have a single integrated electronic patient health record across all locations and settings of care in the public health system of The Bahamas. Against this backdrop, the PHA has continued over this fiscal year the process for the procurement and implementation of an integrated Health Information Management System (i-HIMS) with EMR which would be used at all public hospitals and the community-based Clinics. With this approach no matter where the patient accesses the service within the public sector, the patient’s information would be available, in real time.
The selection process is being finalized at the policy level of my government; and it is anticipated that implementation will begin shortly, with completion over 18 months.
Princess Margaret Hospital
Mr. Speaker, during my last address, I advised that a Master Planning exercise is underway at the nation’s premier health facility, the PMH. This exercise encompasses the preparation of a functional programme and site plan for redevelopment of the hospital on its existing site, leading to a modern, efficient, economical, and adaptable health facility that will support the delivery of high quality patient care well into the next century. I am pleased therefore to report, that the first draft of this plan is now in hand.
Additionally, Mr. Speaker, it is noted that an architectural firm has been engaged by the PHA to undertake assessments for urgent renovations and expansion works to two specific areas of the PMH, the Maternity Ward, A&E Department and several other areas of the hospital. This is seen as an interim solution to address the severe space constraints and infrastructural deficits in high volume areas of care. The key objective of the Maternity Ward renovation project is to create an improved and more efficient space for clinical services as well as general support connected to these areas. It will also provide an opportunity to upgrade essential life safety systems and provide for a more comfortable and aesthetic space for our patients and care providers. The Tender for this area will be executed before the end of this month and work is expected to begin in July of this year.
Accident & Emergency Department
Mr. Speaker, with respect to Accident & Emergency Department, we will be seeking to increase the footprint of this area to relieve the severe problem of overcrowding, improve patient waiting times, enhance the environment of care and improve patient satisfaction.
Following completion of the planning, design drawings and tender within the next two weeks, it is anticipated that construction will begin in August of this year.
In light of the above major infrastructural works, it is important for the PHA to address operational issues for improved efficiency and quality of care in these areas. For this reason, the PHA has undertaken an ancillary project, assisted by an operational consultant, which will review the above and other relevant service areas to identify opportunities for optimizing efficiency, strengthening quality of care (including policies, procedures and work flows), for improved patient and staff satisfaction and health outcomes. This exercise will produce an Action Plan for implementing the recommended improvements, beginning within this fiscal year.
Grand Bahama Health Services
Mr. Speaker, the Rand Memorial Hospital has limited patient care areas. With a view to addressing these challenges in a comprehensive and sustainable manner, the Public Hospitals Authority in collaboration with the Ministry for Grand Bahama, engaged GESAworld USA, a Health Facilities Planning firm, to provide consultancy services on the redevelopment of the Rand Memorial Hospital. The scope of services in this regard included:
- Updating of the Master Plan for the Redevelopment of Rand Memorial Hospital prepared by Dorset Management Consulting;
- Updating of the Freeport Community Clinic Plan; and
- Development of general recommendations for the future use of the current hospital
In this vein, my Government has agreed to the first phase of the redevelopment of the Hospital, with the construction of the most modern and much needed Primary Healthcare Clinic for the Freeport Area on fifty (50) acres of land located on the western side of Sunrise Highway in Grand Bahama. Mr. Speaker, I have no doubt that the Minister for Grand Bahama will share more on this significant accomplishment when he makes his contribution.
Additional capital works planned include:
· Construction of an eight-bedded Private Ward;
· Two (2) four-bedded Public Wards;
· On-Call facilities for our Doctors; and
· A mall to connect the existing Rand hospital to a New Kitchen and Cafeteria.
It is anticipated that these works will be completed within eight months of contract signing.
Community health needs are also being addressed in the form of renovations and expansion of the clinic located in West End to better serve clients in that district of Grand Bahama. Upgrades will also be undertaken at a leased facility to accommodate expansion for much needed clinical spaces within the existing hospital facility.
Sandilands Rehabilitation Centre
Mr. Speaker, I am pleased to report that efforts are underway to improve the patient care experience of our long term clients residing at the Geriatric Hospital. The Culmer’s Ward, a male geriatric ward, will be undergoing extensive renovation to provide additional patient support areas and accommodate the reorganization of the bed space. Work is expected to be begin in April and will be completed within four months. This improved facility will allow residents to move into a more inviting and comfortable living space.
I am also pleased to advise that after much searching and due diligence, a new space has been identified on Collins Avenue to accommodate the relocation of the Community Counseling and Assessment Centre on Market Street that provides outpatient mental health care services. This augurs well as we have a duty to provide publically acceptable outpatient services to residents in need of our assistance, particularly in the current social and economic climate.
Emergency Medical Services
Mr. Speaker, in support of the pending launch of NHI, the PHA has sought to procure additional emergency units for distribution to the poly clinics in New Providence, in Grand Bahama, Abaco, Eleuthera, Exuma and Andros. This is in keeping with the Government’s approved commitment to resource identified zones in an effort to decrease response times to an acceptable standard of 10 minutes from receipt of call to arrival on the scene in New Providence and Grand Bahama. To this end, ten (10) ambulances have been ordered and are expected to be in country by the first week in May, 2016. An additional fifteen (15) ambulances will be ordered shortly, to meet the ever increasing demand on our pre-hospital services.
Mr. Speaker, these are exciting times for Healthcare providers, stakeholders as well as the general public to be a witness to this positive transformation of the Healthcare System; “right before your eyes”. Over the coming months, the buzz started within the Bahamian households will get louder as people in various sectors of the country begin to experience the tangible positive changes in healthcare that will modernize healthcare, make healthcare more accessible while removing all barriers to equitable delivery of quality healthcare services. The perceived inequities of the quality of healthcare services between the private and the public sectors are being addressed and all the perceived gaps will be closed.
Mr. Speaker, this is the dawning of a new era in healthcare delivery, the history of healthcare is being written with the emphasis on wellness, prevention and a holistic approach to healthy living and quality of life years. The old adage: “The Health of the Nation is the Wealth of the Nation” is still very true but I close with a thought shared by the Indian Guru Mahatma Ghandi:- “Your Health is your Wealth”. Fellow Colleagues and Peoples in the Bahamas I wish you all improved quality of Life years and May God Bless the Commonwealth of The Bahamas.
Mr. Speaker, I am pleased to support the 2015/2016 Mid-Term Budget review presented by the Prime Minister and Minister of Finance and Minister of Finance, the Right Hon. Perry Gladstone Christie in building a better Bahamas.
Thank You.
By the Hon. M. Perry Gomez, M.P., Minister of Health
Source: Bahamas Information Services
