Is health reform alive?

The main components of the programme include: (a) reforming the Ministry of Health (into a policy, planning, sponsorship and regulatory body); (b) returning service delivery and management to Regional Health Authorities (RHA), which will contract with the Ministry of Health (MOH) to provide a cost-effective balance of public and private services within global budgets; (c) developing a human resources strategy, including a new funded pension plan for RHA staff, to achieve appropriate skill mixes and staffing levels; (e) rationalising health services and infrastructure, emphasising preventive and promotive services and strengthening primary care; and (e) developing a comprehensive financial strategy for the sector, including evaluation of user charges and a national health insurance system as potential financing mechanisms.

The perils of Health sector reform are now being manifested with all the unsociable activities which we are seeing taking place on a daily basis. The application of this institution has failed us miserably and one wonders why money and I may say large sums of money are being pumped into the Regional Health Authorities annually.

To highlight the kind of money one can remember the level of corruption that existed in these said authorities. The components of the programme are very ambitious but in 1996, were we as a nation ready for this type of development process when in truth and in fact our society is one mirrored by traditionalism and not rationalism? Sentimentalism is a Trinidadian’s way of life that is why government after government, politician after politician will go down the road of welfarism. The mean justifies the end and in this case votes.

Health sector reform at the present moment is at a standstill. Health services in the public institutions are free again yet it is not available equitably. Poor people still have to go through the rigours of being patients. The national health insurance system has in no way assisted the suffering of poor people since it is still to be implemented. The proliferation of private institutions has compounded the situation. Poor people do not have the money or medical plans that are necessary for transacting such business.

Today it has become very challenging to find the appropriate level for the making and implementation of policy and administration in the health care system in this country. The decentralisation process, which is part of the Health Sector Reform programme appears to be an ongoing cycle in which the purveyors are constantly searching for the right balance of efficiency and responsiveness. Looking at the argument, for or against, in many cases the same reasons are used to justify movement in opposite directions. I posed this public question: Is decentralisation of the health sector a purely politically driven phenomenon or is it the wrong instrument used for the right objective?

In defense of decentralisation, John Stuart Mill stated that “local provision is able to put to use local goodwill, enthusiasm and knowledge. Services can be more easily tailored to the requirements of local people which can vary greatly from one place to another”. On the opposite side, most commonly are arguments that have at their heart the belief that greater efficiency and cost effectiveness is possible in more centralised system.

My concern is how long those in the lower socio-economic grouping will continue to suffer for proper health care?

Valentine Smith

Senior Lecturer, Cipriani College of Labour and Cooperative Studies, Valsayn