Healthy Jamaicans, Healthy Environment – MOH Focus

It is said that the first wealth is health, and with the Government’s plan to have the country achieve developed country status by 2030, the Ministry of Health and Environment (MOHE) is moving to ensure that all Jamaicans are healthy by then.

As part of this thrust, the ministry has already embarked on a transformation and restructuring programme to ensure all Jamaicans can access quality health care. The programme is expected to cost almost $1.5 billion, with about $300 million being spent in the first phase.

The MOHE has faced severe criticism for the state of the plants and shortage of key staff. Questions have also been raised about the effectiveness of the Regional Health Authorities(RHAs).

According to the ministry, many of these criticisms are justified and it recognizes the need to employ a new approach to health provision.

Questions have also been raised about another aspect of the transformation process, which is the abolition of user fees at public health institutions, and whether it is sustainable in light of the current global economic crisis.

The Ministry’s Change Management Specialist, Sandra Graham, says a major aspect of the transformation is its restructuring. She says the ministry has already defined for itself a new vision statement; ‘Healthy People, Healthy Environment.’

The MOHE has also developed a new mission statement, and will soon unveil to the public its objectives as a corporate entity.

Mrs. Graham says that the ministry is re-examining the functions of its institutions and agencies. Included in this is the separation of corporate and human resources functions. Most human resources functions will be centralized and will be carried out at the ministry’s head office in downtown Kingston.

The relevance of the Regional Health Authorities to health delivery is also being reviewed.

“It’s as if we have said, 10 years after establishing the Regional Health Authorities, let’s go back to the drawing board: What did we do well? What didn’t we do so well?” She notes.

The ministry is also working on improving its public image. Already, a new website has been unveiled and improvements made to its physical appearance. There will also be strengthening of communications between the various arms and the public, in order to have a stronger presence.

“We need to have good health to be able to reduce poverty, because you need people who can work. If you really look at it, the foundation to a wealthy country, a country that is going to be sustainable, is the health of the nation. So we are very aware of this, and that is part of the reason we need to reposition this ministry to make people understand how important their health is to sustainable livelihoods,” she explains.

One year after the universal abolition of user fees in public health facilities, the ministry says the policy, implemented by the current administration, fits in very well with moves to strengthen health care provision.

“It’s a matter of choosing what will give you the greatest outcome. When you remove user fees, you remove a major impediment to access to health. By bringing more people to your facilities, you will eventually improve the health outcomes of the nation.” Mrs. Graham assures JIS News.

She argues that criticisms regarding the policy and government’s ability to sustain it are unfounded, as user fees forms less than 11 percent of the ministry’s entire budget. And, according to her, this figure has gotten even smaller in light of the current recession.

“It’s very likely that we would have seen a further decline in utilisation at our health facilities because of our user fees policy, and an increase in poverty if the government had retained user fees at our health facilities,” she tells JIS News.

The policy has also acted as a catalyst for the transformation process, causing the ministry to re-evaluate the way it has been functioning, as well as to strengthen areas of weakness.

“In a sense the abolition of user fees has been a blessing for us, in that we have been able to say ‘hold on, it’s time for us to go back and make some changes.’ So that urgency, that consistent urgency for change, has been maintained,” she adds.

One area in which the MOHE has gone back to the drawing board is primary health care. Though the importance of this aspect of health care has long been acknowledged, many of the centres have fallen into disrepair.

Chief Medical Officer (CMO) in the ministry, Dr Sheila Campbell-Forrester, says because health centres(clinics) were underfinanced, many patients began seeking medical attention for simple ailments at hospitals.

She says the abolition of user fees also gave the ministry an opportunity to address areas such as immunization and vector control, especially with the re-emergence of diseases such as malaria.

The ministry says it is seeking to redistribute resources, in order to build confidence in the ability of the health centres to properly serve their communities.

“At the moment we are developing a policy, which looks at placing additional staff in primary healthcare,” Miss Graham states. Included in this is the redeployment of staff from some hospitals to the centres.

Dr Campbell-Forrester also says the ministry will be training health aides to address staffing shortages. Of critical importance is the training of pharmacy technicians, patient care assistants, anaesthetics technicians, community and other health aides. The ministry is also training pharmacists, nurses and doctors in an effort to fill the gaps in the cadre of over 1,660 critical health staff.

A major aspect of the transformation is a renewed focus on monitoring and quality improvement.

At the primary health care level, the Quality Improvement Programme seeks to ensure that the service delivered at the centres are of a standard that will ensure that patients do not feel they are getting service that is inferior to that offered in hospitals.

In the wider health sector, the ministry has instituted checks and balances to ensure that each person associated with the ministry is performing his or her duty. Included in this are systems to ensure the ministry gets value for money out of all of its projects.

Mrs Graham tells JIS News that the ministry has revised the terms of reference, work plans and evaluation forms of senior heads in the head office and the regions. The Performance Management and Appraisal System will be implemented during the first quarter of the 2009/2010 financial year.

The ministry has also placed a renewed focus on customer service, she says.

“Yes, it is difficult for our staff on the front lines, but a little more restraint, a little more patience and a little more understanding is going to be required of our staff,” she adds.

Cost containment is also one of the most important priorities in the transformation process.

The ministry has identified areas such as leave, utilities, travel and the purchase of stationery as those in which it could realise significant savings. It estimates that these cost-saving initiatives will save the government about $31.5M.

Though some activities, such as the improvement of infrastructure and increasing of resources available at the primary health care level, will be costly, most of the activities that will take place under the transformation will be low cost or no-cost.

Mrs. Graham cautions, however, that the ministry has just began the journey towards transforming itself, and there is much more to be done.

“We are working at it, and we are asking the people of Jamaica to be patient and to work with us and co-operate with us. We think this policy is a good policy and that it will redound to the good of the Jamaican people and the nation,” she concluded.