Acknowledgements
Mr. Speaker, I am privileged to be a Member of this Honorable House and to represent the people of Jamaica as their Minister of Health. I wish to thank the Most Hon. Prime Minister for the confidence she reposed in me with such an important portfolio.
I am grateful to the staff of the Ministry of Health including the Regional Health Authorities and the agencies of the Ministry for the support and dedication to the development of health care for the people of Jamaica. I thank Permanent Secretary, Dr. Jean Dixon and the senior management team for the leadership support in a time when the country faces tremendous financial and other resource difficulties.
I extend my gratitude to the Directorate of the Boards who accepted the appointments to serve. I look forward to your leadership at the local level to ensure that the policy directives of the Government are implemented efficiently and effectively. The framework that we have established for ongoing dialogue will ensure that our programmes remain relevant to the needs of our citizens and responsive to the changing environment.
Mr. Speaker, I offer strong commendations to the thousands of health care and administrative workers who continue to go above and beyond the call of duty to secure the health and wellbeing of the Jamaican people.
On behalf of the people of Jamaica, I thank the development partners who continue to support our programmes to advance the health agenda. I would like to make special mention of:
President’s Emergency Programme For AIDS Relief (PEPFAR) supported by the Government of the United States of America
USAID
Global Fund
World Bank
IDB
European Union
The Pan- American Health Organization/World Health Organization
UN Agencies such as UNICEF, UNAIDS and UNFPA
The Caribbean Community and the various CARICOM agencies
The Government of Cuba
The Government of Spain
Volunteer Missions, including Chain of Hope and members of the Jamaican Diaspora.
While I thank the development partners, I must also commend the many organizations in Jamaica, private and non-government sectors that continue to support our work towards achieving improvements in the health status of the Jamaican people.
Constituency of Eastern St. Thomas
Mr. Speaker, I have been fortunate enough to be able to represent the people of Eastern St. Thomas for nearly two decades. I would not be before this Honorable House today without their support. I feel their love, I receive their votes of confidence and with God’s help there will be balance between my constituency demands and my responsibilities as Minister. I will not disappoint!
As a developing country we continue to face challenges, many of them exacerbated by the ongoing global dilemma. There are issues of poverty, aging infrastructure, and high levels of unemployment, crime and violence. Eastern St. Thomas is no exception.
As a Government, we continue to work to overcome these barriers to development and I commit to facilitate development in my constituency so that every family can be empowered to realize their full potential.
Mr. Speaker, let me provide some details of plans for my Constituency:
· Close to 50 beneficiaries of Dumfries will be receiving their land titles this month.
· Housing Agency of Jamaica will be moving to finalise the regularization of the lands at Fort in Leith Hall.
· Lands at Hectors River, Spring Gardens, Wheelersfield, Donaldson, Stokes Hall and England will be pursued this year.
· Over 486 new housing solutions will be coming for sugar workers at Golden Grove Barracks and Ivan Scheme, under the new Sugar Transformation Project. Sugar workers will be relocated to Stokes Hall and Hampton Court.
· JEEP phase 2 will focus on the Bath to Hordley main road.
· Easy Living road at Nutts River and Lane road in Airy Castle will be reconstructed this year under the CDF project.
· New basic school to be constructed in Port Morant.
· Bursaries for top boys and girls for performance in GSAT from 21 primary schools.
· Summer employment project for 35 tertiary level students.
· Patching of the main road from Morant Bay to Hectors River will commence shortly.
· Over $30 million will be expended to renovate Lyssons Sports Complex.
· Perimeter fencing of the Princess Margaret Hospital will be undertaken this year
· New x-ray machine coming this year for Princess Margaret Hospital.
· Sewage treatment works coming for the hospital.
· Cabinet has approved the contract to Stanley Consultants to do the feasibility and design works for rehabilitation of the Harbour View to Port Antonio corridor under the Southern Coastal Highway Project.
· Planning and Design for the Rudolph Elders Park from the CDF.
· Clearing of the vegetation along the main roads as part of the road maintenance programme.
QUALITY HEALTH CARE FOR ALL:
FULFILLING THE MISSION, ADVANCING THE VISION
Introduction
Mr. Speaker, this year, the country observes 50 years of independence. This is a period of reflection for all of us. As we examine the successes and challenges, we must take a strategic approach to preparing the road map for the future. We have to keep our finger on the pulse of the events taking place outside our borders. All available intellect must come on board to shape the future.
Mr. Speaker, this Administration recognizes health as a developmental imperative. It is well articulated in our Manifesto commitments. Let me highlight a few aspects of the health related section:
· We advocate and will work towards achieving a health system in which there is a balance between preventive and curative care with the emphasis on prevention.
· We advocate and will work towards achieving a health system that is not based on persons’ ability to pay.
· We will build a health system that is supported by appropriate technologies
· One that is innovative in the provision of services.
· One that facilitates public/private partnerships.
Mr. Speaker, we are laying the foundation for a brighter, healthier future; an emphasis on providing quality health care for all with universal access at the primary health care level. In this way we can achieve the mission of Jamaica being that place of choice to live, work, raise families and do business as outlined in our development agenda, Vision 2030.
In examining our past experiences, we must focus not only on our successes but also our challenges, in order to chart the future course for the generations to come.
Mr. Speaker, at no time during the history of Jamaica’s health services have external factors; in particular, changes in the global situation had such a profound impact on the health conditions of our country. This impact has led to changes influencing what we eat and drink, how we live, work and relate to each other and the styles of life which we adopt.
Our health service has come a far way over fifty years. In this year of our 50th year of our Independence I wish to give a brief historical synopsis of our journey.
Seven years prior to Independence in 1955 the Medical Department which was under the jurisdiction of the Governor was incorporated into the Ministry of Health. We now had a Minister of Health, Chief Medical Officer and Permanent Secretary. Hookworm infestation and TB were reduced considerably by 1962. Major successes just after Independence were the eradication of yellow fever, malaria and yaws which took place in the early to mid 1960s. The re-emergence of malaria in 2006 and its rapid control is testament to the continued vigilance and high standards of practice of our Public Health professionals.
What were the prevailing health conditions prior to Independence? The findings of Lord Moyne’s Commission adequately summarize this.
· The cure of disease received much more attention than its prevention.
· Much ill-health arose from poverty; poverty of the individual, of the medical departments and of governments.
· Much ill-health was of a preventable nature and much arose from ignorance.
· The high rate of illegitimacy combined with large families, and a lack of parental responsibility were serious factors in health.
· Housing accommodation for the poorer people in the West Indies was generally deplorable & general sanitation was primitive.
· Little improvement in the health of the people was expected no matter how extensive the hospital facilities were. This would continue until such defects are remedied.
· Relatively too large a proportion of the available funds and medical efforts were expended on curative medicine and too little on prevention.
· There was neglect of rural districts in favor of the urban areas.
The Commission offered several recommendations:
· The creation of at least one School of Hygiene with the training of auxiliary medical personnel.
· The centralization of medical institutions for the training of all classes of medical personnel.
· The reorganization of the medical services for the better balance between preventive and curative medicine.
The Moyne Commission further noted that a minimum of ten percent of the National Budget should be spent on health care services.
Are the conditions today better than the days of our colonial rule? There is no comparison.
Let’s briefly examine the post-independence period. The past fifty years have seen great advances in our health status.
1962-1972
The highlight of the period 1962 to 1972 was the introduction of the National Family Planning Policy and the development of institutions and services to give effect to the policy. This watershed initiative gave rise to long awaited changes in fertility resulting in the decrease in the rate of population growth. The resultant social and economic benefits are still being reaped today.
The building of the Cornwall Regional Hospital (CRH) was another highlight of this period.
1972 to 1980
· The development of an Environmental Control Unit in the Ministry of Health laid the basis for the creation of the present environmental monitoring and control institutions.
Social legislations such as equal pay for women; maternity leave with pay, and changing the Bastardy Law contributed to the transformation of the status of women, children and the family, having a profound effect on Public Health practice and outcomes.
A new policy to accommodate women and infants attending maternal and child health clinics produced improvements in the immunization status of children.
New Primary Health Care initiatives including:
An expansion in the role of the district midwife to include immunization in the health sector, in addition to doing home deliveries
The expanded role of the nurse to include the nurse practitioner
A National breast feeding campaign (breast is best) and
Strong community participation in health care at the health centre level through community health committees.
National nutrition education program created conditions for the mitigation and eventual control of prevalent nutritional diseases such as Marasmus and Kwashiorkor. Thousands of Jamaican children suffered from these conditions prior to and during the early years of our Independence when infant mortality rates were over 48per thousand live births, and children up to five years was over 60/ 1000 live births.
Immunization coverage against vaccine preventable diseases increased from an average of 47% in 1976 to over 75% by 1980. Mr. Speaker, let me use this opportunity to remind today’s parents of where we are coming from; a time when children used to contract diseases, such as polio, that left them paralyzed. There is an emerging unfounded argument against the benefits of immunization and we have seen the outcome; polio, measles and other vaccine preventable diseases have re-emerged in those countries where some persons have refused to accept vaccination for their children.
Providing universal access to basic primary health care throughout Jamaica through the establishment of a strong network of health centres each serving specific catchment populations.
Improved services at the community level through the assistance of Cuban health professionals.
1980 to 1989
Introduction of oral rehydration salts for the treatment of children with diarrhoeal diseases, thus reducing the case specific mortality rates
Significant improvement in water quality through better chlorination and monitoring of water supply systems
Salt fluoridation to reduce tooth decay in the child population.
1989- 2011
Continuation of policies of upgrading hospitals.
Divesting training institutions for nursing and Public Health to tertiary level training institutions.
Developing a policy to enable funding for research and development in the area of health information technology.
Accelerating the reform process of decentralization, with autonomy, in the creation of the regional health authorities.
New methods of financing the health sector in the creation of the National Health Fund and Mr. Speaker,
Subsidized pharmaceuticals for elderly patients and for patients with certain chronic diseases
Major upgrading of the health infrastructure- physical and equipment,
The removal of user fees for services in the public sector
The creation of the landmark legislation, the Child Care and Protection Act and the establishment of the Child Development Agency.
Mr. Speaker, Independent Jamaica has made significant gains in health.
What therefore are the main challenges informing the present policy direction of this Government?
Mr. Speaker; Globalization will continue to exert a significant impact on the health conditions of Jamaica now and in the foreseeable future. This influence is manifested in the following ways:
A. Advances in science and technology continue to shape how health care is delivered and the techniques we use to deliver it.
B. The rapid changes in the conditions and patterns of diseases as a result changes in the global environment have shaped how we live, eat, work and relate to each other.
C. Health care services are presently recognised as being a very important contributor to the growth and development of the services sector which presently accounts for approximately 81%of Jamaica’s Gross Domestic Product. In that connection, the contribution of Health Tourism, which represents the rapidly growing global health export sector, becomes crucial to sustainable health development.
D. Adaptation of a national health agenda for sustainable development must be in concert with the prevailing global trends especially in the areas of climate change, disaster management and multi-culturalism including adoption of the principle of diversity in human discourse and relationships.
E. The adoption of global standards which are evidence based and which promulgate best practice at all levels of the health care services delivery system is the only way to ensure sustainability and optimum outcomes to the Jamaican people.
This conceptual framework, Mr. Speaker, represents the essence of my Ministry’s policies and programs over the next five years.
A. In meeting the challenge of the Advances in Science and Technology I am mindful of the 2008 Review of the Health Sector[1] by Professor Winston Davidson, which reported on the general state of affairs in the health institutions. The report highlighted:
· Non-Functional Equipment.
· Inadequate Maintenance.
· Lengthy procurement procedures for equipment. It cited as an example, that three quotes were needed for the purchase of selected items even when only one or two entities had dealership arrangements.
· The report recommended the formulation of policies for the standardization of all categories of machinery and equipment, especially with regard to energy conservation and replacement parts.
Mr. Speaker, I have put in place an Equipment Performance Taskforce (EPTF) to develop a framework for the optimal use of medical equipment and to help us to standardize our equipment procurement.
The proposed policy framework will guide the management of medical equipment in the Public Health Sector, and among other things will:
· Provide the overarching framework for the development of operating, preventative maintenance and equipment replacement procedures; which, when implemented, will ensure that the established equipment performance standards are maintained,
· Recommend training for the personnel who will operate the equipment,
· Strengthen the existing mechanisms for monitoring and reporting on the performance of medical equipment; including a database of medical equipment,
· The development of a list of the minimum medical equipment required for the effective delivery of Primary Care and Dental Health Services.
On the recommendation of this Taskforce, the Ministry applied for, and received permission from the National Contracts Commission to standardize on the manufacturer for X-Ray equipment, autoclaves and patient monitors and we expect this element of the work to continue.
B. The rapid changes in the conditions and pattern of diseases as a result of changes in the global environment continue to have a major impact on our health conditions notwithstanding the gains we have made especially in immunization coverage.
Mr. Speaker, in the area of immunization coverage, Jamaica has been recognized among the most successful countries in Latin America and the Caribbean region by the Pan American Health Organization (PAHO). Our programme is cited as a model for other nations. This foundation was laid for this in the 1970s Last year, the country achieved a hundred percent coverage for tuberculosis (BCG), 92 percent for polio, diphtheria, pertussis or whooping cough and tetanus (DPT), hepatitis B and haemophilus influenza type b (HIB) and 88 percent coverage for measles, mumps and rubella (MMR).
In 2007 and again in 2011, Jamaica won the Henry C. Smith Immunization Award. This award is given to the country that has made the most improvement in its Expanded Programme on Immunization (EPI) for the year.
Some of the gains that we boast today have been built on the foundation of a strong primary healthcare system. This is characterized by a good network of community based health centers, hospitals that were strategically located, active community participation in health and a well-trained and dedicated cadre of health care professionals and the provision and expansion of the health infrastructure.
Mr. Speaker, I would like to take this opportunity to invite all my Parliamentary colleagues to view the display on immunization and the wide scope of our health profile in the lobby.
C. Health care services are recognised as being a very important contributor to the growth and development of the services sector which the most recent estimates put at 81.5% of Jamaica’s Gross Domestic Product. In that connection, the contribution of Health Tourism which represents the rapidly growing global health export sector becomes crucial to sustainable health development.
Jamaica must participate in the emerging opportunities that Health Tourism offers. Health Tourism, Mr. Speaker, is essentially the practice of traveling to a tourist destination with the main purpose of receiving health care. Mr. Speaker, if there is one policy in the health sector which unites both parties it is that related to Health Tourism.
Mr. Speaker the previous administration had initiated a public private demonstration project involving the University of the West Indies, the University of Technology, the Private sector consortium of Columbus Flow, Jamaica National MCSystems, Telegens Ltd and Telemedicine Ltd. In this partnership, the Government is represented by the National Health Fund, the Mandeville Hospital and the University Hospital of the West Indies. This demonstration project will establish the basis for building the Health Tourism infrastructure capacity for Jamaica. We are actively pursuing this course in cooperation with the Ministry of Tourism, the Ministry of Industry, Investment and Commerce and the Planning Institute of Jamaica.
Mr. Speaker, why is Health Tourism a good prospect for Jamaica? There are three essential factors which separate Jamaica’s health tourism market from all other countries in Latin America and the Caribbean. They are:
The global competitiveness of Jamaica’s health service.
The quality and sustainability of Jamaica’s health service system.
The committed political will.
Other critical factors include:
Jamaica’s much lower cost per capita for health care, estimated to be 10 to 20 times less than the cost in the US, Canada and Europe.
The high quality of patient/customer care
High patient/customer satisfaction
Jamaica’s history and culture of excellent service in the tourism sector
The reputation of the high quality of service of the Jamaican health professional. In particular the reputation of the Jamaican doctor and the Jamaican nurse working in the US, Canada and the UK is legendary.
Easy accessibility and efficient cross-border payment and reconciliation
Jamaica has developed its electronic medical records system which is in compliance with HL7 and HIPAA standards for seamless portability of data and insurance coverage between Jamaica and the US or any other country.
High level integrity for patient data storage, confidentiality, security and tele-health broadband platform among a host of other pluses.
New Children’s Hospital
Mr. Speaker, on the insistence of the Prime Minister, The Most Honourable Portia Simpson Miller, The Peoples National Party Manifestos of 2007 and 2011 made a commitment to the country, to build a state-of-the-art Child and Adolescent Hospital in Western Jamaica.
Mr. Speaker I am happy to report that within six months of taking office we have completed the epidemiological studies and the results justify the establishment of this facility. Mr. Speaker, we have identified the land, finalized the preliminary design and the costing for this project. This project, Mr. Speaker, will become a National Center of Excellence and an example of best practice for Public Private Partnerships.
D. Developing a national health agenda for sustainable development must take cognizance of prevailing global trends.
The Health agenda for sustainable development must always take the impact of the environment into account. The malaria organism was reintroduced into Jamaica in 2006, after 50 years of being declared malaria free. This outbreak eventually affected 154 persons. That was a timely reminder of the need to maintain vigilance in preserving environmental health.
We continue our preparation activities to mitigate against the risks of new and reemerging disease threats, such as Cholera. This epidemic has killed several thousand persons in Caribbean countries in close proximity to Jamaica.
The Inter-Ministerial Committee set up by Prime Minister Portia Simpson Miller to implement a National Clean-up and beautification program could not have occurred at a more opportune time. I must pay tribute to my colleague Minister Senator Sandrea Falconer and to Dr. Marion Bullock DuCasse, the Director of Emergency, Disaster Management and Special Services, of the Ministry of Health for the work that they have been doing to advance the very important initiative.
In keeping with this initiative, my Ministry is now on full alert and I therefore make a special appeal to the people of Jamaica to play their part in practicing the highest level of personal and community hygiene.
E. The adoption of global standards which are evidence based and best practice at all levels of the health care delivery services system is the only way to ensure sustainability and best outcomes in the health care delivery services. In this connection, the application of modern Information and communication technology systems are the key.
Mr. Speaker, we need to have reliable data to develop evidence-based policies; to inform decision-making; and, for monitoring health indicators. It is no secret that we need to improve our records management systems. One important data source for the MOH is the paper based patient medical records.
We have undertaken an assessment of the national health information system in collaboration with the Pan American Health Organization (PAHO). The report indicated that there is a need to improve the Information and Communication Technologies (ICT) infrastructure, the policy and legislation framework, the related human and financial resources and overall data management. The Ministry has taken these findings seriously and we are applying the attention and resources to secure improvements in a realistic and carefully planned manner.
Mr. Speaker, I am pleased to announce that we have secured funding from the World Bank to develop a National Strategic Plan for NHIS strengthening and modernization, over the six-month period from July-December 2012.
We continue to conduct activities to improve the existing paper-based system in preparation for the design and establishment of EHR. Attention is also being given to the Information Governance requirements for the EHR, with specific attention to security, privacy and confidentiality.
Primary Health Care Renewal
Mr. Speaker, the policy initiatives that this Government will pursue, include the efficient and effective renewal of Primary Health Care. Mr. Speaker, I intend to pursue the process in earnest, in this my first year as Minister. We will focus on specific areas including:
· Community participation
· The development of a modern health information and communication infrastructure
· Integration of services for a seamless referral of patients between the primary and secondary levels
· The provision of adequate diagnostic, laboratory and pharmaceutical services
· Renewal of the ‘health team’ approach to health care delivery
· The necessary logistic and administrative support.
Mr. Speaker, I believe that we must bring health services closer to the community.
Centres of Excellence
Mr. Speaker, during this financial year, we will initiate the establishment of four centres of Excellence at the primary care level, one in each of the four Regional Health Authorities. Planning has been far advanced and I have the funding to do it! This Honourable House approved $100M as part of the Appropriations-In-Aid allocation to be provided by the NHF for this project.
Mr. Speaker, we are not on a frolic. There is strong rationale for our action. We are driven by a set of clear imperatives:
1. The PNP’s 2011 Election manifesto commits to universal access at the primary level of care.
2. The available epidemiological evidence
3. The change in Jamaica’s morbidity profile over the last 50 years from a preponderance of communicable diseases to Non Communicable Diseases
4. The economics. Unit cost for treatment at the primary level is significantly lower than at the secondary or Hospital level.
Mr. Speaker, we have the evidence, and our actions must be driven by this evidence. The criteria for selection of the centres to be upgraded to Centres of Excellence were also well thought-out:
1. First, they must be in a location that is accessible and is likely to remain accessible and open for business even in the event of a natural disaster.
2. Second, they must be at least a type Three Centre which already has a fairly good infrastructure. The reason for this readily suggests itself, as it is not the intention to spend all of the available resources on infrastructural improvements.
3. Third, they must themselves have the physical space or be expandable to accept further infrastructural and other improvements
4. Fourth, they must have an appreciable patient demand based on epidemiological and demographic profiles.
On these bases, therefore, we have selected 4 Health Centres, one in each Region as follows:
· In Southern Regional Health Authority – Santa Cruz Health Centre in St Elizabeth
· In Western Regional Health Authority – Darliston Health Centre in Westmoreland
· In Northeast Regional Health Authority – Claremont Health Centre in St. Ann
· In South East Regional Health Authority – Isaac Barrant Health Centre in St. Thomas.
Mr. Speaker, let me share some of the improvements that will be undertaken:
· We will expand the waiting areas and make them more customer friendly.
· We will focus on offering health promotion and education programmes.
· We will upgrade the diagnostic services to support screening and treatment of patients.
· Certainly Mr. Speaker, my colleagues in this Honourable House would expect me to say that Dental services will be offered, and so say I!
· Efficient and effective pharmacy services will be available.
· Mr. Speaker, we will be increasing the number of health professionals working in these Centres.
· A web-based electronic Health Information System will be introduced, which will establish the platform for tele-medicine services,
· Mr. Speaker, we will be extending the opening- hours of the Centres.
The monitoring and evaluation results will inform further reconfiguration of the primary health care system and will provide guidance for the upgrade of other health centres.
Mr. Speaker, I am hoping that we will be able to demonstrate in these Centres, that the physical resources and equipment will only enhance the caring, compassionate human touch in providing quality care.
Primary Health Care Infrastructure Improvement Project
We have distributed maps indicating the location of health centres in the four Regional Health Authorities and I urge my colleague Parliamentarians to guide and advise your constituents to use their health centres. Hospitals are for more complicated and emergency cases.
Mr. Speaker, I wouldn’t want this Honourable House to be left with an impression that this is the only intervention to strengthen the Primary Health care system. I am happy to inform the House that over eighty (80) health centres have already been refurbished through funding from the NHF, JSIF and CHASE. Thirty two of the facilities are within the South East Region, eighteen in the Western region, twenty two in Southern and sixteen in the Northeast region.
Mr. Speaker, work is continuing on a number of other health centres across the island including:
· Brainard in St. Mary (South East St. Mary)
· James Hill (Northern Clarendon)
· Rocky Point (South-East Clarendon)
· The Portland Health Department (East Portland)
· Glengoffe in St. Catherine (North-East St. Catherine)
· Exchange in St. Ann (North-East St. Ann)
· Sandy Bay in Hanover (Eastern Hanover) and
· Mt. Salem in St. James (contract ready to be signed), [Central St. James]
The use of the Primary Health care facilities as the first port of call for the communities is important especially in the face of the epidemic of Chronic Non communicable Diseases, many of which are preventable through interventions at that level.
The Impact of NCDs
My Ministry is finalizing the first comprehensive strategic plan for the prevention and control of NCDs. This will address the four major NCDs causing death and morbidity in Jamaica – Cancers, Diabetes, Cardiovascular Disease and Chronic Respiratory Diseases. It will also address the four major risk factors: tobacco smoking, lack of exercise, poor nutrition and harmful alcohol use. I will say a little more about tobacco control later. This plan has been subjected to broad stakeholder consultation and we have their commitment to join this battle to reduce the impact of NCDs.
As a member of the government, I am concerned about the financial cost to treat NCDs. As an example, one course of radiation treatment is about $1.5M. I am concerned about the impact of NCDs on productivity. Mr. Speaker, as a health professional I am concerned about the suffering that I see. I am concerned about the quality of life that our citizens experience. As a human being, I empathize with all care givers who bear the burden, much of it emotional, when our loved ones suffer.
Mr. Speaker, the NCD epidemic puts the future of our children at risk. It has the potential to erode gains in areas such as education. If not managed, it will condemn us to perpetual poverty.
To be able to make a meaningful impact on the NCDs in the context of existing constraints, we must focus our efforts. Mr. Speaker, I have determined that we will give priority attention to strengthening systems to deliver cancer-care more effectively and efficiently.
Mr. Speaker, the limited Cancer Registry, which captures data only for Kingston and St. Andrew shows that during the period 2003 – 2007:
· A total of one thousand and forty two (1,042) men were diagnosed with cancer of the prostate, the leading cause of death among men. Other major cancers occurring in men include lung cancer of which there were 242 cases, mainly caused by cigarette smoking and, 229 cases of colon cancer.
· For the same period, seven hundred and twenty (720) women were diagnosed with breast cancer, the leading cause of death among women, three hundred and two (302) had cancer of the cervix, one hundred and seventy seven (177) had cancer of the womb, and two hundred and thirty one (231) had cancer of the colon.
· Children are also affected by cancers – such as leukemia and cancer of the brain.
Mr. Speaker, apart from those outlined above, there are many other types of cancers affecting the Jamaican population and there is an increasing trend in the occurrence of many of these cancers.
The impact of cancer can be devastating on the affected individual, the family, community, the health system and society as a whole. I do not want this or any of my future presentations to sound like a dirge to cancer patients, Mr. Speaker, because there is hope and the negative impact of cancer can be reduced so that there are better health outcomes. I intend to pilot the charge down the road that leads to a broad spectrum attack on cancer: prevention, screening, early diagnosis, treatment, rehabilitation and palliative care. I invite all Jamaicans to join me on this mission.
I am prepared to work with voluntary organizations like the Jamaica Cancer Society, and the Jamaica Medical Foundation, in their excellent work on cancers.
We will, on a phased basis, streamline the cancer care path and systematically remove the bottlenecks. Let me give you an example, as a first step we must become current in providing timely results on biopsy samples. Here I again pause to thank my counterpart Minister Dr. Roberto Morales Ojeda of Cuba. Despite their own shortage of Pathologists, he has agreed to make available one of seven that will graduate in a few months. Mr. Speaker, if there are retired specialists and /or private sector companies that offer these services, I am prepared to sit and talk with them now.
Mr. Speaker, I’ve made presentations to several groups overseas in which I’ve extended an invitation to partner with us to strengthen our systems to deliver cancer care services.
Mr. Speaker, the International Atomic Energy Agency (IAEA) has accepted my invitation to field an imPACT mission to undertake an assessment and formulate a cancer control plan for Jamaica. Mr. Speaker here I will also indicate that we are seeking to re-introduce nuclear medicine technology to enhance our diagnostic and treatment capabilities for cancer and other chronic diseases.
Mr. Speaker, improving cancer care must be a national effort. Government, Private Sector, the NGO community, Faith-based Organizations, Community-based Organizations, the Diaspora, and each of us, must co-operate to fulfill this mission. Already, philanthropic groups locally and overseas are raising funds for state-of-the-art diagnostic and treatment equipment. Given the enormity of the challenge, I appeal to our development partners and other well-thinking groups to join this initiative.
Tobacco smoking is the leading risk factor for NCDs. Globally, five million persons die each year as a direct consequence of tobacco smoking, that is Mr. Speaker nine persons every minute. Twelve percent of the deaths are attributable to exposure to second hand smoke. My Government is determined to protect the Jamaican population from the consequences of tobacco consumption.
Mr. Speaker, the former Cabinet had given drafting instructions in relation to the Public Health Act. However, certain issues were found to be incompatible with that approach. Therefore we are pursuing a comprehensive tobacco control law to address issues such as trade, manufacturing, distribution to minors and licensing of distributors. The aim is to reduce demand for tobacco products over time, protect vulnerable persons and prevent the illicit supply of tobacco products.
Mr. Speaker I have grave concerns as the impressionable adolescents is the group being seduced into the practice of tobacco use and the products are becoming more and more innovative.
Further consultations are being pursued to inform a new Cabinet Submission. Mr. Speaker, rest assured that there will be adequate provisions to deal with breaches.
Delivery of Pharmacy Services
Mr. Speaker, pharmaceuticals are indispensible in the management of the NCDs. This is where the burden of these diseases is most felt. For example, of the US$3.2 billion estimated for the management of HIV patients over the next 18 years, US$1.4 billion will be used to provide Anti-retrovirals. Mr. Speaker, It is estimated that approximately 8% of the Jamaican population is being treated for diabetes at a cost of about J$1.6 billion per annum.
Mr. Speaker, the pharmaceutical budget is the single largest expenditure on goods and services in the public health budget. An efficient system for procurement, distribution and dispensing is therefore critical. Before the end of this financial year, the National Health Fund will assume responsibility for providing pharmacy services in the public sector. Here, Mr. Speaker, I pause to recognize the Member from Southeast Clarendon who presided over the integration of the Health Corporation Limited and the National Health Fund.
Oral Health Services
Mr. Speaker, dental services could be considered the poor cousin in the family of health services. However, oral diseases and conditions are important public health concerns because of their high prevalence, severity, public demand for services and because of their impact on individuals and society. The combined effects of the negative consequences of poor oral health such as pain, discomfort, handicap, social and functional limitations, and the financial burden on quality of life have been largely ignored.
Expensive technology-driven approaches to Oral Health have not addressed the key determinants of Oral diseases, which include poor oral hygiene practices, diabetes and high sugar consumption. The implementation of salt fluoridation in the 1980’s was in fact the single most successful intervention reflected in a reduction of the prevalence of tooth decay in children.
There will be some significant changes in Dental Health services going forward:
· I will ensure the timely development of a relevant and modern legal framework to govern and regulate Oral Health services. Mr. Speaker, I have appointed a new Dental Council, Dental Auxiliary Advisory Body and the Dental Appeals Tribunal.
· A deepening of the integration of oral health care into all services offered at the health centres.
· Mr. Speaker, we will align Oral Health Goals with the national health goals.
· We will establish minimum standards of care for Oral Health
· There will be a focus on vulnerable communities and at-risk groups
· Mr. Speaker, we will strengthen Oral Health Service delivery while maintaining the gains and
· Emphasize Dental health in our promotion and education programmes.
As a Dental Surgeon, I am well aware of the challenges facing Oral Health Services in Jamaica, more particularly the shortage of dental health professionals. Mr. Speaker, here I pause to thank the few dental health professionals who have remained faithful to this calling.
Between 1978 and 1989 Mr. Speaker, I served as the only Dental Surgeon in the Parish of St. Thomas. I saw first-hand the dental needs of my fellow Jamaicans. I am too aware of the inequitable distribution of Dental Professionals throughout our country. Mr. Speaker, rural communities need dentists too. I could not be criticized then Mr. Speaker, for my stance on this important service. I will implement pragmatic short and medium term strategies, to address the issues of the Dental Workforce and to enhance access for the most vulnerable and at risk communities.
Mr. Speaker, I am pleased to announce that, for the first time in our history, six dental Surgeons from Cuba will be made available to work at the primary health-care level in rural Jamaica. I am using this opportunity to thank ambassador His Excellency Yuri Gala Lopez who was instrumental in paving the way for the discussion between my Cuban counterpart, Dr. Roberto Morales Ojeda and I. Mr. Speaker, the stars are well aligned. The first time a Dental Surgeon is the Minister of Health coincides with this historic event; and on this, the 50th year of our Independence.
Public/Private Partnership
Mr. Speaker, the Government cannot continue to provide all the startup financing required to update and modernize our health infrastructure and delivery systems. Public Private Partnerships is seen as the ideal mechanism, a win-win-win arrangement that creates entrepreneurial opportunities, provides an opportunity for private investments and allows the Government optimal use of its fiscal space.
The Ministry of Health has had a number of ‘partnership’ arrangements outside of a prescribed policy guideline. Mr. Speaker, The Government of Jamaica has now given the DevelopmentBank of Jamaica (DBJ) the mandate to develop a national policy framework for Public Private Partnerships. Within this policy framework Mr. Speaker, the Ministry will enter into further PPP arrangements taking account of the requirements specific to health and health care.
Mr. Speaker, having a structured public private policy guideline will seek to streamline PPP arrangements, improve transparency and broaden access. We viewPublic Private Partnerships asan avenue through which the government can cut costs, reduce risk, while simultaneously increasing coverage levels, output quality and efficiency.
Almost all areas in the public health system can benefit from public private partnerships. However, the Ministry of Health will seek to promote the following areas based on overall strategic and policy direction:
· Technologically intensive services such as cancer treatment and dialysis
· Infrastructure development
· Health Information Management Systems
· Pharmacy services
· Diagnostic services
· Health Promotion Interventions
· Non clinical support services
· Training and Research.
Jamaica/Cuba Bilateral Partnership Agreements
Mr. Speaker, Jamaica has enjoyed excellent relations with the Government and people of Cuba for decades; in December of this year, we would have achieved forty years of diplomatic relations. We are strengthening our fraternal cooperation in the area of health services and have entered into a number of agreements geared at improving the health of the Jamaican people.
Two weeks ago, I led a delegation to Cuba to discuss with my colleague Minister, pertinent matters in relation to existing and additional areas of cooperation in health. While there, we signed an Agency Agreement in support of the Bio-Medical Services Arrangement now being implemented. This makes the third agreement for the health sector that my Administration has signed with the Government of Cuba since I took office in January. The other agreements were:
The renewal of the Technical Cooperation Agreement, and
The renewal of the Agreement for the Jamaica/Cuba Ophthalmology Centre.
Mr. Speaker, as we examine our obligations to the Jamaican people and respond to changes in the disease and the epidemiological profiles of the country, we have to look at ways to respond to new and emerging health threats and trends. This requires that we provide the resources to meet the emerging demands.
Based on these demands, it has become necessary to source specialist skills for certain areas of the health sector. I want to stress that the personnel we are recruiting have skills that are not readily available to us locally. We will not be seeking any human resource for positions that we can fill with our local cadre of professionals.
Mr. Speaker, I wish to announce that in addition to the six dentists, the Government of Cuba will for the first time also provide us with 1 Nephrologist, 1 Paediatric oncologist,1 Neonatologist and 1 Pathologist.
Mr. Speaker, it takes 2-4 years to graduate a specialist in the health sector and we continue to lose our highly skilled workers to the more developed countries which are more competitive in terms of salary and benefits. Recruitment of human resources in health is one of our strategies to fill positions for which skills are not locally available or in the numbers that we need.
Update on Biomedical Agreement
Mr. Speaker, an adequately equipped health service is essential to achieving positive health outcomes. As I indicated, a few days ago I signed an Agency Agreement for the procurement of spare-parts to support the Biomedical contract in which our equipment is being repaired and serviced. This programme will result in a significant improvement in the way in which equipment is maintained in the public health sector. It will also increase the number of working equipment we have in our facilities.
The Biomedical team comprised of Jamaican and Cuban engineers have so far visited 20 hospitals and 98 health centres and assessed a total of 370 pieces of equipment. From this assessment a detailed spare-parts list has been submitted for procurement. Additionally, procurement of parts for dental equipment has already started and some equipment repairs have been done.
The biomedical engineering project has led to more effective management of our equipment, increased confidence in equipment repairs and functionality, increased availability of equipment and significantly reduces down time. The sharing of knowledge of the Cuban team is also important and has resulted in a knowledge transfer to our local cadre of biomedical engineers.
Conclusion
We are well on our way to building the type of health sector that will aid in our development, one that will adequately serve the needs of our population. The Ministry will continue its focus on those activities that will help us to maintain the achievements that we have made, pave the way for additional accomplishments and build on the gains of the past half a century.
Mr. Speaker, we continue to strengthen our relationship with our development partners.
I have demonstrated by evidence that we have made tremendous strides in our health care services since independence.
Mr. Speaker, against the background of globalization we have developed a clear vision to achieve quality health care for all.
We have identified areas in which we can establish win-win-win arrangements in public private partnerships.
Mr. Speaker, in keeping with the principle of joined-up government, we are on the cusp of participating in the new global health economy – Health Tourism.
Mr. Speaker, in responding to the health demands of our people:
We will establish a children and adolescent hospital in Western Jamaica
We will improve and develop primary health care delivery systems
We will spend $100 million to establish four Centres of Excellence to deliver quality health care at the primary level
We will improve access to dental care services by provide dentists to underserved areas
We will improve the spectrum of cancer care services and broaden treatment modalities
Mr. Speaker, for the first time at last we have an Equipment Performance Task Force which includes public and private sector professionals
We will begin to repair and restore to service hundreds of pieces of equipment in our facilities
Mr. Speaker we are going to focus on dealing with the scourge of NCDs in our society
Mr. Speaker, the Tobacco Legislation is going to be a reality this year to protect the health of our people.
Mr. Speaker, we will strengthen our systems to deliver more effective and efficient pharmacy services
Mr. Speaker, through legislation we will continue to remove stigma and discrimination against persons living with HIV/AIDS.
Mr. Speaker, this Government is standing firm with its commitment to the Jamaican people to provide quality health care for all: Fulfilling the mission, advancing the vision.