Ministry of Health Addressing Delays at Public Hospitals

The Ministry of Health and Environment is working on reducing the delays being experienced by the public at Government health facilities.
This has been confirmed by Senior Medical Officer (SMO) at the Kingston Public Hospital (KPH), Dr. Patrick Bhoorasingh, who admits that the waiting time is the main area of concern for patients visiting the hospital, since the removal of user fees on April 1, 2008.
Dr. Bhoorasingh assured the public, however, that during the process of reducing the waiting time, no patient would be ignored.
“There is no patient who will suffer. With the system that we have in place, they’re not in any danger of dying before getting help,” he said.
While emergency cases are seen as urgent, each patient is assessed upon entering the hospital and is attended to based on priority, he explained.
A patient with an elective case may have to wait up to five hours to be examined by a doctor, but this is a slight increase in waiting time, compared with the period prior to the abolition of user fees, Dr. Bhoorasingh commented.
The KPH, situated on North Street in downtown Kingston, is the premier health facility in the Caribbean. Its Accident and Emergency (A&E) Department, alone, handles approximately 250 visitations daily, the worst days being Mondays and Tuesdays, and the highest patient loads usually during the morning and afternoon shifts.
Dr. Bhoorasingh revealed that the A & E and Eye Operation departments have seen visitations rise by about 60 per cent, in each case, since the removal of the fees.
Minister of Health and Environment, Rudyard Spencer, said that visitations at the hospital saw an overall 50 per cent increase within the first two weeks of the removal of the fees. In other areas, such as pharmaceutical services, the increase was in the region of 100 per cent at some facilities.
These increases, said Dr. Bhoorasingh, have undoubtedly contributed to the long delays experienced by patients, but it was predictable.
“That’s the whole idea of free health care. These patients, who could not afford it in the past, are now able to access care. It means that care is not limited to anybody,” he said.
Dr. Bhoorasingh said that there has been a lot of commendation and appreciation expressed by the patients who no longer have to pay for medical care at the institutions.
Chief Medical Officer (CMO) in the Ministry, Dr. Sheila Campbell-Forrester, said Jamaicans had saved more than $1 billion in disposable income since the implementation of the policy.
The services for which fees were waived at public health facilities last April include: registration; doctor’s examination; surgeries; medications; diagnostic services (x-rays and lab tests); haematology; antenatal care (such as family planning and pregnancy tests); ambulance service; physiotherapy; and renal dialysis.
The primary aim of the policy, as outlined by the administration, is to erase an impediment to poor Jamaicans accessing health care, by providing equity in medical treatment in the public sector while hastening the repositioning of primary health care as the foundation of a sustainable health system.
One beneficiary, Ruby Palmer, said she was surprised that she did not have to pay for sutures to one of her toes, which was sliced by zinc sheets in her backyard.Miss Palmer, who had visited the Princess Margaret Hospital in Lyssons, St. Thomas last October, was not perturbed by the waiting period. Instead, she was elated that she could leave the medical facility without having to open her purse and with her injured toe bandaged.
“It was late (about 7:00 p.m.), no doctor’s office was opened. They (relatives) rushed me out there (Princess Margaret Hospital) and I was fine. I walked out without paying a cent. That was great!” said Miss Palmer.
Another beneficiary, Althea Martin, is extremely pleased that she does not have to pay anymore for ophthalmology services at KPH. Ms. Martin has a cataract condition and sometimes twice per year she is referred to the hospital.
“I used to pay sometimes up to $6,000 per visit. Now I don’t pay at KPH. I can also visit the clinic (in her community) for my eye checkups, which are also free, plus when I visit the clinic, I get my teeth cleaned too, which is also free,” said Ms. Martin.
With specialist services also being offered free of cost at public health facilities, the waiting period for these specialised services have increased.
Dr. Bhoorasingh said public hospital administrations and the Government were working together to find medical personnel in specialist areas, such as cancer care, to reduce the waiting period faced by these patients.
Some patients seeking cancer care at the facility are often placed on a waiting list, sometimes for months before being seen by a doctor.
Staffing is a critical ingredient in the smooth delivery of health care and, while cashiers have been deployed to customer service areas at the health facilities, finding adequate staff to fill all the needs has been a challenge.
But, Dr. Bhoorasingh said that it was expected that there would not be sufficient staff to cover the heavy workload, because staffing needs are not easily filled.
“Staff cadres cannot be upgraded overnight. But, since the first of April, we have been in the process of employing staff in the areas where they are needed most. We are still not up to the required cadre, but we have improved significantly,” he said.
The lack of training facilities for individuals entering the medical field is also a setback, in terms of sourcing personnel for the health care system.
There is one institution that offers training for medical doctors, the University of the West Indies UWI) in collaboration with the University Hospital. The UWI graduates students, at most, twice per year, hence the limited cadre of medical professionals entering the health field.
“We can only plan to employ these people whenever they have graduated from the programme. Otherwise, we will have to advertise for expatriates,” said Dr. Bhoorasingh.
President of the Jamaica Association of Social Workers, Beverley Clarke, agreed that the policy was benefiting the needy and vulnerable within the society. However, she wants to see much more done to reduce waiting time and accessibility of drugs.
“It’s a saving for the family. Just that, when we take our children to the hospitals, we wait forever [and] we can’t get medication. Those are the major stumbling blocks,” said Mrs. Clarke.
Another way of reducing waiting time, is enhancing and improving the role of community or primary health care centres, the health experts suggest.
The issue of patients visiting hospitals with ailments that can be treated at the health clinics is being addressed. A number of visitations at hospitals, such as KPH, which are really emergency facilities, can be cared for at health centres.
“For the future, if we can educate the patient to seek help from primary health care clinics first, it would save them a lot of time and money, and the ones who really need to come to the hospital would be referred,” said Dr. Bhoorasingh.
Dr. Campbell-Forrester said that the Government will strengthen its focus on primary health care during the next fiscal year (2009/2010), as a part of securing the nation’s health outcome.
“Our programme of primary health care renewal will push people back to the health centre setting, which will reduce the overall cost of providing health. We must reduce the 88 per cent self-reference rate to many of our public hospitals, by investing in health at the primary health care level,” said Dr. Campbell-Forrester.
Despite the challenges, Dr. Bhoorasingh insists that the aim of providing health care to the poor was being fulfilled, with the abolition of user fees.
“It’s really a good venture; it’s a good gesture for the patient. A significant number who had no hope to access health care, can now come to the hospital,” he said.