Making the climb to better healthcare management

Dr. Christopher Tufton

Gleaner Archive – January 26, 2020

Jamaica’s current dengue outbreak is occurring on a scale unprecedented for the island, representing a crisis to which the Ministry of Health and Wellness has had to make rapid adjustments in its planning for and delivery of care to the public.

We have made, and continue to make, those adjustments, and with some fair results, despite prevailing resource and infrastructure constraints. The evidence is in the number of Jamaicans whose lives have been saved, having been admitted to hospital for suspected or confirmed dengue.

As at January 13, the ministry had in its database 9,356 suspected and confirmed cases with dates of onset of symptoms in 2019. Of those, 1,692 were admitted to hospital; 96.2 per cent were discharged home; and 3.8 per cent died. Of the 1,066 suspected and confirmed cases in 2018, 365 were admitted. Of those admissions, 95.3 per cent were discharged home while 4.7 per cent died.

Still, the loss of even a single life is tragic. As a result, the ministry has redoubled its efforts to ensure the best possible health outcomes for Jamaicans in this current crisis and others that are to come. And crises will come. This is the nature of public health and a reality that Jamaica must face, with its ageing population and a health profile that shows an increasing number of us with non-communicable diseases such as heart disease and diabetes.

These are factors that deepen our vulnerability to public-health crises, including not only disease outbreaks, but also other sources of risk such as natural hazards and climate change. The impact of climate change and its obvious link to the dengue outbreak locally and in the wider region of the Americas cannot be ignored.

It is against this background that the ministry has adopted a more tactical approach to this most recent crisis, which sees us concerned with not only responding to the immediate risk, but also with building resilience.

INVESTED IN RESEARCH

We have invested in research around the breeding of the mosquitoes and will be implementing a programme to sterilise the Aedes population. The effect will be to reduce their numbers, and, by extension, the threat of dengue and other mosquito-borne diseases.

The ministry has also invested in our laboratory facilities, which has resulted in confirmatory dengue testing being done locally, providing clinicians with test results within two to three days rather than the customary six to seven days when samples were being sent to the Caribbean’s regional laboratory.

We have, too, adopted a whole-of-government approach to the response efforts, mobilising ministries, departments, and agencies to collaborate to safeguard the population – including at the National Dengue Clean-up this weekend and with the development and implementation of an overall Enhanced Vector Control Programme for which a billion dollars has been made available.

Meanwhile, the health systems in Jamaica over the last 30 years, have not received the required resources to keep pace with the emergent demands. Government’s fiscal contribution has been increased over recent years by more than 100 per cent to the now 4.2 per cent of GDP but remains below the World Health Organization-recommended six per cent.

We have not seen the construction of a new hospital in 30 years, but the population has grown by 40 per cent over the same period. UNOPS, in its 2018 report of the health infrastructure in Jamaica, which I commissioned, reveals that over 70 per cent of the equipment and infrastructure are at end of life.

STRATEGIC THINKING

Coupled with poor health-seeking behaviour that increases morbidity within the population, these are factors that, together, necessitate strategic thinking and not mere tactics. As such, the ministry has developed three main strategic documents to strengthen the health systems and right-size the infrastructure.

These plans – including the Vision 2030 Plan for Health, the Capital Investment Expenditure Plan for Health, and the National Health Insurance Green Paper, all tabled in May last year – are now being implemented. In line with their provisions, we have so far negotiated with the Inter-American Development Bank and the European Union financing, to the tune of more than US$60 million, for the development of three hospitals and 10 health centres.

Through the National Health Fund, we have also improved eight hospitals and health centres to the tune of more than J$700 million and enhanced pharmacy services for public patients through the J$270-million renovation of 60 Drug Serv pharmacies and significantly reduced waiting times. In addition, we have initiated a national discussion on health financing.

At the same time, we have championed personal responsibility in health and promoted and adopted strategies for disease prevention. The development and implementation of Jamaica Moves stands testimony to this. The obvious effectiveness of messaging and behaviour-change communication in this initiative cannot be denied. Its success is widely recognised by the Pan-American Health Organisation and the World Health Organization, while other countries have sought to copy the programme.

There remains room for improvement in our planning for and management of public- health crises, including resilience building as a critical component of those efforts.

Yet, we have made important progress over recent months and years and invite the continued support of Jamaicans in whose interest we labour.